Objective To develop an ethically, legally, and clinically appropriate ventilator allocation policy for AdventHealth Tampa and AdventHealth Carrollwood in Tampa, Florida, which could be enacted swiftly during the Covid-19 pandemic. Methods During Spring 2020, a subcommittee of the Medical Ethics Committee established consensus on the fundamental principles of the policy, then built on existing ethical, legal, and clinical guidance. Results The plan was finalized in May 2020. The plan triages patients based on exclusion criteria (imminent mortality), prognosis and expected benefit (...) of ventilation (using the Sequential Organ Failure Assessment), and change in prognosis over time. Decisions are made by committee in order to minimize moral distress among individual patient care providers. Conclusions Due to international concerns about healthcare resource shortages during the Covid-19 pandemic, hospitals need allocation policies informed by the crisis standard of care, the hospital’s ethical duty to plan for an emergency, and federal civil rights laws Policy Implications: This type of policy can serve as a model for other institutions to develop crisis standards of care resource allocation policies, which are a necessary component of disaster planning. (shrink)

Between the Psyche and the Social is the first collection that specifically features the field of psychoanalytic social theory emerging in and between psychoanalysis, feminism, postcolonial studies, and queer theory, and across the disciplines of philosophy, literary, film, and cultural studies. This collection of essays takes the psychoanalytic study of social oppression in some new directions by engaging—indeed, stirring up—unconscious fantasies and ethical tensions at the heart of social subjectivity.

Payment to recruit research subjects is a common practice but raises ethical concerns relating to the potential for coercion or undue influence. We conducted the first national study of IRB members and human subjects protection professionals to explore attitudes as to whether and why payment of research participants constitutes coercion or undue influence. Upon critical evaluation of the cogency of ethical concerns regarding payment, as reflected in our survey results, we found expansive or inconsistent views about coercion and undue influence (...) that may interfere with valuable research. In particular, respondents appear to believe that coercion and undue influence lie on a continuum; by contrast, we argue that they are wholly distinct: whereas undue influence is a cognitive distortion relating to assessment of risks and benefits, coercion is a threat of harm. Because payment is an offer, rather than a threat, payment is never coercive. (shrink)

Experiments are commonly thought to have epistemic privilege over simulations. Two ideas underpin this belief: first, experiments generate greater inferential power than simulations, and second, simulations cannot surprise us the way experiments can. In this article I argue that neither of these claims is true of experiments versus simulations in general. We should give up the common practice of resting in-principle judgments about the epistemic value of cases of scientific inquiry on whether we classify those cases as experiments or simulations, (...) per se. To the extent that either methodology puts researchers in a privileged epistemic position, this is context sensitive. (shrink)

Institutional Review Board decisions hinge on the availability and interpretation of information. This is demonstrated by the following well-known historical example. In 2001, 24-year-old Ellen Roche died from respiratory distress and organ failure as a result of her participation in a study at Johns Hopkins Asthma and Allergy Center. The non-therapeutic physiological study, “Mechanisms of Deep Inspiration-Induced Airway Relaxation,” was designed to examine airway hyperresponsiveness in healthy individuals in order to better understand the pathophysiology of asthma. Participants inhaled hexamethonium, a (...) chemical ganglionic blocker that was not FDA-approved for use as specified in the experimental protocol. Risks of inhaling hexamethonium, including lung damage, had been reported in the 1950s and ‘60s. An investigation conducted after Roche's death determined that the study's principal investigator had failed to adequately search the medical literature; the protocol submitted for IRB review cited articles indexed in online literature databases that went back only as far as the 1970s. (shrink)

The question of authenticity centers in the lives of women of color to invite and restrict their representative roles. For this reason, Gayatri Chakravorty Spivak and Uma Narayan advocate responding with strategic essentialism. This paper argues against such a strategy and proposes an epistemic understanding of the question of authentic- ity. The question stems from a kernel of truth—the connection between experience and knowledge. But a coherence theory of knowledge better captures the sociality and the holism of experience and knowledge.

There is considerable agreement among epistemologists that certain abilities are constitutive of understanding-why. These abilities include: constructing explanations, drawing conclusions, and answering questions. This agreement has led epistemologists to conclude that understanding is a kind of know-how. However, in this paper, I argue that the abilities constitutive of understanding are the same kind of cognitive abilities that we find in ordinary cases of knowledge-that and not the kind of practical abilities associated with know-how. I argue for this by disambiguating between (...) different senses of abilities that are too often lumped together. As a consequence, non-reductionists about understanding—those that claim that understanding-why is not reducible to knowledge-that—need to find another way to motivate the view. In the end, the fact that abilities are constitutive of understanding-why does not give us reason to conclude that understanding is a kind of know-how. (shrink)

Medical ethics assumes a clear boundary between clinical research and clinical medicine: one produces knowledge for the benefit of future patients, while the other provides optimal care to individuals right now. It also assumes that the two cannot be integrated without sacrificing the needs of the current patient to those of future patients. But integration could allow us to provide better care to everyone, now and in the future.

As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted (...) a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male, white, between 50 and 69 years old, of non-Hispanic origin, and of Roman Catholic faith. Nearly half were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making, goals of care/treatment, and end-of-life. More specifically, capacity, patient’s wishes/autonomy, and surrogate decision maker were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment, patient wishes/autonomy, and capacity. Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field. (shrink)

_Philosophers consider race and racism from the perspective of lived, bodily experience._.

Ontological separation plays a key role in Aristotle’s metaphysical project: substances alone are ontologically χωριστόν. The standard view identifies Aristotelian ontological separation with ontological independence, so that ontological separation is a non-symmetric relation. I argue that there is strong textual evidence that Aristotle employs an asymmetric notion of separation in the Metaphysics—one that involves the dependence of other entities on the independent entity. I argue that this notion allows Aristotle to prevent the proliferation of substance-kinds and thus to secure the (...) unity of his metaphysical system. (shrink)

The omen of the door and the eagle at Iliad 24.314–21 appears to have sparked scant scholarly interest, but deserves careful attention. The omen itself forms part of an analogy, for the eagle is likened in the size of its wingspan to a large, barred door. This simile might seem unremarkable, merely a convenient means of depicting great size, a casual juxtaposition of two ordinary nouns. The omen, on the whole, might be dismissed as nothing more than a conventional expression (...) of divine favor. But closer scrutiny will reveal that there is, in fact, nothing arbitrary or haphazard in the selection of the terms of the analogy. Appreciation of the elegance and subtlety of the simile in turn reveals the full import of the omen. (shrink)

Where ethical or regulatory questions arise about an individual’s interests in accessing bioinformation about herself, the value of this information has traditionally been construed in terms of its clinical utility. It is increasingly argued, however, that the “personal utility” of findings should also be taken into account. This article characterizes one particular aspect of personal utility: that derived from the role of personal bioinformation in identity construction. The suggestion that some kinds of information are relevant to identity is not in (...) itself new. However, the account outlined here seeks to advance the debate by proposing a conception of the relationship between bioinformation and identity that does not depend on essentialist assumptions and applies beyond the narrow genetic contexts in which identity is customarily invoked. The proposal is that the identity-value of personal bioinformation may be understood in terms of its instrumental role in the construction of our narrative identities, specifically that its value lies in helping us to develop self-narratives that support us in navigating our embodied existences. I argue that this narrative conception provides useful insights that are pertinent to the ethical governance of personal bioinformation. It illuminates a wider range of ethical considerations in relation to information access; it accounts for variations in the utility of different kinds of information; and it highlights that the context in which information is conveyed can be as important as whether it is disclosed at all. These arguments are illustrated using an example drawn from psychiatric neuroimaging research. (shrink)

Exploring the intimate tie between body movement and space and time, Lee begins with the position that body movement generates space and time and explores the ethical implications of this responsibility for the situations one’s body movements generate. Whiteness theory has come to recognize the ethical responsibility for situations not of one’s own making and hence accountability for the results of more than one’s immediate personal conscious decisions. Because of our specific history, whites have developed a particular embodiment and body (...) movement that generates places that can only be characterized as more comfortable and more enabling to whites. (shrink)

This chapter responds to Michael Tamir and Elay Shech’s chapter “Understanding from Deep Learning Models in Context.”.

Utilizing Maurice Merleau-Ponty’s work, I argue that the gestaltian framework’s co-determinacy of the theme and the horizon in seeing and experiencing the world serves as an encompassing epistemological framework with which to understand racism. Conclusions reached: as bias is unavoidably part of being in the world, defining racism as bias is superfluous; racism is sedimented into our very perceptions and experiences of the world and not solely a prejudice of thought; neutral perception of skin color is impossible. Phenomenology accounts for (...) the dynamic changes in expressions of racism and the interconnections of both race and sex for women of color. (shrink)

Despite frequent calls by players, managers and fans, FIFA's resistance to the implementation of goal-line technology (GLT) has been well documented in national print and online media as well as FIFA's own website. In 2010, FIFA president Sepp Blatter outlined eight reasons why GLT should not be used in football. The reasons given by FIFA can be broadly separated into three categories; those dealing with the nature and value of the game of football, those related to issues of justice, and (...) those concerned with the practical implementation of GLT. This paper intends to evaluate these eight reasons in order to assess whether there are, indeed, any good arguments against GLT in football. (shrink)

This paper puts forward a new interpretation of the argument at Philebus 36c–40d that pleasures can be false. Protarchus raises an objection at 37e–38a, and in response Socrates presents the elaborate painter-scribe analogy. Most previous interpretations do not explain how the analogy answers Protarchus’ objection. On my account, Protarchus’ objection relies on the plausible intuition that pleasure is simply not in the business of assessing the world, and so it cannot be charged with doing so incorrectly. Socrates responds by demonstrating (...) that pleasure can be mistaken about the world, despite not making an independent assessment of it. The painter-scribe analogy demonstrates how pleasure comes to be mistaken about the world by reproducing the mistake of a judgment. Socrates persuades Protarchus that pleasure can be mistaken in part by preserving his intuition that pleasure itself is not the source of the mistake. (shrink)

In this paper, I discuss the recent discovery of alleged arsenic bacteria in Mono Lake, California, and the ensuing debate in the scientific community about the validity and significance of these results. By situating this case in the broader context of projects that search for anomalous life forms, I examine the methodology and upshots of challenging biochemical constraints on living things. I distinguish between a narrower and a broader sense in which we might challenge or change our knowledge of life (...) as the result of such a project, and discuss two different kinds of projects that differ in their potential to overhaul our knowledge of life. I argue that the arsenic bacteria case, while potentially illuminating, is the kind of constraint-challenging project that could not—in spite of what was said when it was presented to the public—change our knowledge of life in the deeper sense. (shrink)

Aristotle claims that just as a builder uses ‘tools’ to build a house, so too the soul ‘use[s] heat and coldness as tools’ to build an animal (Generation of Animals 740b25–34). I consider two questions about this claim: (1) what sorts of things does the soul use, and what is it for things like them to be organized? and (2) what philosophical work does this sort of organization do in Aristotle’s account of animal generation? I argue that the soul needs (...) flexible intermediate agents, that it organizes them in a way that exploits their flexibility, and that this is due to the demands of a complex, multi-stage process directed at a single end. (shrink)

The tendency for emotions to be predictable over time, labelled emotional inertia, has been linked to low well-being and is thought to reflect impaired emotion regulation. However, almost no studies have examined how emotion regulation relates to emotional inertia. We examined the effects of cognitive reappraisal and expressive suppression on the inertia of behavioural, subjective and physiological measures of emotion. In Study 1 (N = 111), trait suppression was associated with higher inertia of negative behaviours. We replicated this finding experimentally (...) in Study 2 (N = 186). Furthermore, in Study 2, instructed suppressors and reappraisers both showed higher inertia of positive behaviours, and reappraisers displayed higher inertia of heart rate. Neither suppression nor reappraisal were associated with the inertia of subjective feelings in either study. Thus, the effects of suppression and reappraisal on the temporal dynamics of emotions depend on the valence and emotional response component in question. (shrink)

Daniel Sennert , a prominent physician and a prolific and influential writer, was both an atomist and an Aristotelian. He was influenced by a distinctive and now little known Aristotelian approach to matter and form, and this promoted his development over time of a hierarchical account of atoms, with elementary atoms and grades of molecules. The first section provides a study of Sennert's Aristotelian foundation. The final two sections consider, in turn, Sennert's development over time of an atomistic theory, and (...) the nature and significance for him of substantial forms. (shrink)

State concussion laws and sport-league policies are important tools for protecting public health, but also present implementation challenges. Both state laws and league policies often require athletes provide written acknowledgement of having received concussion-related information and/or of their responsibility to report concussion-related symptoms. This paper examines these requirements in two ways: an analysis of the variation in state laws and sport-league policies and a study of their effects in a cohort of collegiate football players.

This qualitative study of 27 women animal activists examines the risks and rewards that accompany a commitment to animal rights activism. One of the common beliefs about animal rights activists is that their political choices are fanatic and unyielding, resulting in rigid self-denial. Contrary to this notion, the women in this study experienced both the pain and the joy of their transformation toward animal activism. Activism took an enormous toll on their personal relationships, careers, and emotional well being. They struggled (...) as friendships ended and family relationships suffered; some experienced harassment and abuse as a result of their efforts. Yet the women were just as likely to extol the rewards and pleasure gained from their participation in the cause of animal liberation. These included a heightened awareness of political issues, greater self-confidence, the feeling that they were making a difference in the world, and the joy of living a “more meaningful life.”. (shrink)

Elder abuse presents difficult ethical considerations that the field of psychology has yet to sufficiently address. As demographics and sociocultural factors shift in the coming decade, this deficit in ethical competence may become an increasingly serious problem. Although legal definitions of elder abuse lack uniformity and clarity, there is much room for improvement in the field of psychology. Ethical considerations most relevant to professionals in psychology draw heavily on the principles of beneficence and nonmaleficence and respect for people's rights and (...) dignity. Professional standards of competence, discrimination, informed consent, privacy and confidentiality, and cooperation with other professionals are also critical in these considerations. A number of recommendations are made, centering around the needs for more education, frank discussion, and empirical examination of the complexities of elder abuse. (shrink)

Lexilalia, a kind of repetition disorder or form of ‘repeat-after-reading’, is contextualized in this article as a term for continual or interminable translation. Barbara Cassin has emphasized how one definition of the ‘Untranslatable’ is temporal, associated with a symptomatic condition of ‘keeping on translating’. In extending Cassin's ‘time’ of translation to the psychic condition of translating philosophical terms and working with encyclopedic objects, the article concludes with some reflections on anxiety, concept-making and the death drive.

The concept of cultural landscape was first put to use by the German geographer Friedrich Ratzel in 1895. The American geographer Carl Sauer was probably the first to use the concept in the English language in 1925. In recent years, the concept of cultural landscape has become significant in social and political decision-making, and in environmental management and preservation. Cultural landscape has also become the object of extensive consideration and discussion within diverse academic disciplines and areas of research, such as (...) human geography, cultural anthropology, history, archaeology, biology, and ecology. Depending on the discipline or area of research, focus is directed towards specific features in the landscape that have come about as a result of human activity. This collection of essays is predicated on the view that considerations regarding the cultural landscape have underlying philosophical presuppositions. The authors propose that the cultural landscape be made the focus of environmental philosophy, ethics, and aesthetics. (shrink)

Canada’s Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans mandates that all research involving human subjects be reviewed and approved by a research ethics board . We have little evidence on how researchers are dealing with this requirement in multisite studies, which involve more than one REB. We retrospectively examined 22 REB submissions for two minimal-risk, multisite studies in leading Canadian institutions. Most REBs granted expedited review to the studies, while one declared the application to be exempt from review. (...) Time between submission and approval ranged greatly, from four to 546 days. We received a total of 155 REB queries for changes and clarifications, most of which asked for further information, clarification, or additional documents. Less than a third of the REB queries were requests for specific changes, and a vast majority had a very limited impact on the research projects. Institutions also varied broadly in their description of what was required of local principal investigators. We conclude that the organizational and practical challenges these results imply could deter researchers from embarking on multisite research projects, and that recently proposed changes to the TCPS will not solve these problems. (shrink)

In the early twentieth century, a rare strain of British idealism emerged which took Leibniz's Monadology as its starting point. This paper discusses a variant of that strain, offered by Hilda Oakeley. I set Oakeley's monadology in its philosophical context and discuss a key point of conflict between Oakeley and her fellow monadologists: the unreality of time. Oakeley argues that time is fundamentally real, a thesis arguably denied by Leibniz and subsequent monadologists, and by all other British idealists. This paper (...) discusses Oakeley's argument for the reality of time, and Oakeley's attack on the most famous account of the unreality of time offered in her day: that of J. M. E. McTaggart. I show that Oakeley's critique of McTaggart can be extended to challenge all monadologists, including that of the great monad, Leibniz himself. (shrink)

The early modern Catharine Cockburn wrote on a wide range of philosophical issues and recent years have seen an increasing interest in her work. This paper explores her thesis that immaterial substance need not think. Drawing on existing scholarship, I explore the origin of this thesis in Cockburn and show how she applies it in a novel way to space. This thesis provides a particularly useful entry point into Cockburn's philosophy, as it emphasises the importance of her metaphysics and connects (...) with many of her further philosophical views. This paper shows that it is rewarding to consider Cockburn's philosophical views as a holistic system. (shrink)

This short comment on the Court of Protection decision in W v M draws attention to the primacy the judge gave to the preservation of life and discusses the relative lack of weight accorded to M's previously expressed views.

Play is a vital component of the social life and well-being of both children and adults. This book examines the concept of play and considers a variety of the related philosophical issues. It also includes meta-analyses from a range of philosophers and theorists, as well as an exploration of some key applied ethical considerations. The main objective of The Philosophy of Play is to provide a richer understanding of the concept and nature of play and its relation to human life (...) and values, and to build disciplinary and paradigmatic bridges between scholars of philosophy and scholars of play. Including specific chapters dedicated to children and play, and exploring the work of key thinkers such as Plato, Sartre, Wittgenstein, Gadamer, Deleuze and Nietzsche, this book is invaluable reading for any advanced student, researcher or practitioner with an interest in education, playwork, leisure studies, applied ethics or the philosophy of sport. (shrink)

This book explains the importance of embodiment in understanding the function of race. With chapters by expert contributors and coverage of the most recent thinking in philosophy of race, the book is ideal for upper-level students in Phenomenology, Philosophy of Race and Critical Race Theory.

The consent and community engagement process for research with Indigenous communities is rarely evaluated. Research protocols are not always collaborative, inclusive or culturally respectful. If participants do not trust or understand the research, selection bias may occur in recruitment, affecting study results potentially denying participants the opportunity to provide more knowledge and greater understanding about their community. Poorly informed consent can also harm the individual participant and the community as a whole. Invited by local Aboriginal community leaders of the Fitzroy (...) Valley, the Kimberley, Western Australia, The Picture Talk project explores the consent process for research. Focus groups of Aboriginal community members were conducted to establish preferences for methods of seeking individual consent. Transcripts were analysed through NVivo10 Qualitative software using grounded theory with inductive and deductive coding. Themes were synthesised with quotes highlighted. Focus groups with Aboriginal community members were facilitated by a Community Navigator as a cultural guide and interpreter and a researcher. Participants were recruited from all main language groups of the Fitzroy Valley – Gooniyandi, Walmajarri, Wangkatjungka, Bunuba and Nikinya. Participants were aged ≥18 years, with 5 female groups and one male group. Themes identified include: Reputation and trust is essential; The Community Navigator is key; Pictures give the words meaning – milli milli versus Pictures; Achieving consensus in circles; Signing for consent; and Research is needed in the Valley. Aboriginal communities of the Fitzroy Valley recommend that researchers collaborate with local leaders, develop trust and foster a good reputation in the community prior to research. Local Aboriginal researchers should be employed to provide cultural guidance throughout the research process and interpret local languages especially for elders. Pictures are preferred to written text to explain research information and most prefer to sign for consent. The Fitzroy Valley welcomes research when collaborative and for the benefit of the community. Future research could include exploring how to support young people, promote health screening and improve understanding of medical knowledge. (shrink)

Given that many clinical research studies struggle to meet their recruitment goals, researchers are eager to identify and employ strategies that will maximize reach to eligible and int...

Journal Name: Apeiron Issue: Ahead of print.

In The Gay Science Nietzsche famously writes that “God is dead.” Modern atheists, including “Internet Atheists,” have taken this as their epithet. I argue that the perpetuation of the statement “God is dead” contradicts the atheistic core, such that Internet Atheists parallel theists in identity construction. Insights from Nietzsche, Jean Luc Nancy, Sigmund Freud, and Christopher Hitchens allow for an exploration of the theistic underpinnings of Internet Atheists. The doctrine of Internet Atheism, as it is represented in humorous online depictions (...) of God, suggests an inability to confront the consequences of the death of God, an inability which Nietzsche warns against in the Parable of the Madman. (shrink)

This article provides a conceptual and normative framework through which we may understand the potentially ethically significant roles that information generated by neurotechnologies about our brains and minds may play in our construction of our identities. Neuroethics debates currently focus disproportionately on the ways that third parties may (ab)use these kinds of information. These debates occlude interests we may have in whether and how we ourselves encounter information about our own brains and minds. This gap is not yet adequately addressed (...) by most allusions in the literature to potential identity impacts. These lack the requisite conceptual or normative foundations to explain why we should be concerned about such effects or how they might be addressed. This article seeks to fill this gap by presenting a normative account of identity as constituted by embodied self-narratives. It proposes that information generated by neurotechnologies can play significant content-supplying and interpretive roles in our construction of our self-narratives. It argues, to the extent that these roles support and detract from the coherence and inhabitability of these narratives, access to information about our brains and minds engages non-trivial identity-related interests. These claims are illustrated using examples drawn from empirical literature reporting reactions to information generated by implantable predictive BCIs and psychiatric neuroimaging. The article concludes by highlighting ways in which information generated by neurotechnologies might be governed so as to protect information subjects’ interests in developing and inhabiting their own identities. (shrink)