BackgroundArtificial intelligence has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping (...) review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective?MethodsEight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed.ResultsUpon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries.ConclusionsThe ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere. (shrink)

Public officials rely on performance data that are self-reported by organizations to evaluate progress on a wide range of prosocial outcomes. Policies that require public disclosure of performance in health care are thought to enable patients to select high-quality providers, which in turn may spur quality improvements as providers seek to protect their reputation or increase economic returns. Drawing on institutional theory that examines how conflicting institutional pressures influence organizational decisions, we theorize how profit orientation may mediate the response (...) of health care providers to disclosure mandates in a public health crisis. We focus on measures of data quality—completeness and accuracy—in self-reported data on COVID-19 status and outcomes generated by thousands of long-term care facilities. Using pooled regressions and a difference-in-differences style design, we find that overall, for-profit and not-for-profit facilities report similarly complete data but that for-profit facilities report less accurate data than their not-for-profit counterparts. Our results suggest that it may be important to incentivize each dimension of data quality separately to address differential institutional pressures that affect reporting practices. (shrink)

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the (...) principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career. (shrink)

Dans son nouveau livre, Marie-Paule Ha bouleverse les idées reçues sur le rôle des Françaises dans les colonies. Se concentrant sur l’Indochine, Ha affirme que les femmes françaises n’ont pas tracé une ligne de démarcation stricte entre les colonisateurs et les colonisés. Elles ont bien plutôt inventé des façons diverses de vivre aux colonies, en fonction de leur position sociale, de leur privilèges de « race » et de leur accès à l’administration coloniale. Dans l’introduction, M.-P. Ha situe...

This commentary paper examines the issue of contract cheating in higher education, drawing on research and current debate in the field of academic integrity. Media coverage of this issue has reflected significant concerns in the field about students’ use of custom academic writing services, along with sector and national calls for action that would lead to making such essay mills illegal. However, recent studies have revealed the complex nature of contract cheating, with a relatively low proportion of students engaging in (...) outsourcing behaviours involving a third party. This paper focuses on how universities and colleges can respond to this emergent concern, and proposes that institutions extend and establish strategies to embed the values, principles and practices aligned to academic integrity. As part of this endeavour, five areas of consideration are offered for higher education institutions that relate to: determining academic integrity strategy; reviewing institutional policy; understanding students; re-visiting assessment practices; and implications for staff professional development. (shrink)

This special issue is a collective effort to respond to a growing debate in many fields over the way in which the global and transnational approaches can change our study of the past. Over the last...

Therapists and their patients must deal with the negative sequelae of short term mating strategies. Implications for therapy of Gangestad & Simpson's strategic pluralism theory are compared with those of Buss's sexual strategies theory and Eagly's social role theory. Naive theories held by therapists and patients, as well as prevailing societal views, are posited as influential in determining the course and outcome of therapy.

This paper intends to sum up the main findings of the European project RoboLaw. In this paper, the authors claim that the European Union should play a pro-active policy role in the regulation of technologies so as to inform the development of technologies with its values and principles. The paper provides an explication of the rationale for analysing of a limited and heterogeneous number of robotics applications. For these applications, the following issues are addressed: whether robotics deserve a special case (...) of regulation; the direct and indirect role ethics can play in regulating technology; the transformations of both vulnerabilities and capabilities, and the effects of liability law in favouring the socially relevant applications. In conclusion, a reflection on the possibility to generalize some of the RoboLaw findings to other technologies is proposed, with respect to liability and ethics. (shrink)

Neurocognitive and genetic approaches have made progress in understanding language-music interaction in the adult brain. Although there is broad agreement that learning processes affect how we represent, comprehend, and produce language and music, there is little understanding of the content and dynamics of the early language-music environment in the first years of life. A developmental-ecological approach sees learning and development as fundamentally embedded in a child’s environment, and thus requires researchers to move outside of the lab to understand what children (...) are seeing, hearing, and doing in their daily lives. In this paper, after first reviewing the limitations of traditional developmental approaches to understanding language-music interaction, we describe how a developmental-ecological approach can not only inform developmental theories of language-music learning, but also address challenges inherent to neurocognitive and genetic approaches. We then make suggestions for how researchers can best use the developmental-ecological approach to understand the similarities, differences, and co-occurrences in early music and language input. (shrink)

In Nigeria, as in other developing countries, access to training in research ethics is limited, due to weak social, economic, and health infrastructure. The project described in this article was designed to develop the capacity of academic staff of the College of Medicine, University of Ibadan, Nigeria to conduct ethically acceptable research involving human participants.

According to I3 Theory, individuals enact aggressive behaviors when (a) instigating triggers are severe, (b) impelling forces are strong, and/or (c) inhibiting forces are weak. Archer's analysis of human sex differences in aggression could be bolstered by a careful analysis of male-female discrepancies in reactivity (or exposure) to instigating triggers, proneness toward impelling forces, and/or proneness toward inhibiting forces.

This volume is a comprehensive roadmap to the burgeoning area of affective sciences, which now spans several disciplines. The Handbook brings together, for the first time, the various strands of inquiry and latest research in the scientific study of the relationship between the mechanisms of the brain and the psychology of mind. In recent years, scientists have made considerable advances in understanding how brain processes shape emotions and are changed by human emotion. Drawing on a wide range of neuroimaging techniques, (...) neuropsychological assessment, and clinical research, scientists are beginning to understand the biological mechanisms for emotions. As a result, researchers are gaining insight into such compelling questions as: How do people experience life emotionally? Why do people respond so differently to the same experiences? What can the face tell us about internal states? How does emotion in significant social relationships influence health? Are there basic emotions common to all humans? This volume brings together the most eminent scholars in the field to present, in sixty original chapters, the latest research and theories in the field. The book is divided into ten sections: Neuroscience; Autonomic Psychophysiology; Genetics and Development; Expression; Components of Emotion; Personality; Emotion and Social Processes; Adaptation, Culture, and Evolution; Emotion and Psychopathology; and Emotion and Health. This major new volume will be an invaluable resource for researchers that will define affective sciences for the next decade. (shrink)

We have achieved a residue‐level resolution of genetic interaction mapping – a technique that measures how the function of one gene is affected by the alteration of a second gene – by analyzing point mutations. Here, we describe how to interpret point mutant genetic interactions, and outline key applications for the approach, including interrogation of protein interaction interfaces and active sites, and examination of post‐translational modifications. Genetic interaction analysis has proven effective for characterizing cellular processes; however, to date, systematic high‐throughput (...) genetic interaction screens have relied on gene deletions or knockdowns, which limits the resolution of gene function analysis and poses problems for multifunctional genes. Our point mutant approach addresses these issues, and further provides a tool for in vivo structure‐function analysis that complements traditional biophysical methods. We also discuss the potential for genetic interaction mapping of point mutations in human cells and its application to personalized medicine. (shrink)

Indirect speech acts—responding “I forgot to wear my watch today” to someone who asked for the time—are ubiquitous in daily conversation, but are understudied in current neurobiological models of language. To comprehend an indirect speech act like this one, listeners must not only decode the lexical-semantic content of the utterance, but also make a pragmatic, bridging inference. This inference allows listeners to derive the speaker’s true, intended meaning—in the above dialog, for example, that the speaker cannot provide the time. In (...) the present work, we address this major gap by asking non-aphasic patients with behavioral variant frontotemporal dementia and brain-damaged controls with amnestic mild cognitive impairment to judge simple question-answer dialogs of the form: “Do you want some cake for dessert?” “I’m on a very strict diet right now,” and relate the results to structural and diffusion MRI. Accuracy and reaction time results demonstrate that subjects with bvFTD, but not MCI, are selectively impaired in indirect relative to direct speech act comprehension, due in part to their social and executive limitations, and performance is related to caregivers’ judgment of communication efficacy. MRI imaging associates the observed impairment in bvFTD to cortical thinning not only in traditional language-associated regions, but also in fronto-parietal regions implicated in social and executive cerebral networks. Finally, diffusion tensor imaging analyses implicate white matter tracts in both dorsal and ventral projection streams, including superior longitudinal fasciculus, frontal aslant, and uncinate fasciculus. These results have strong implications for updated neurobiological models of language, and emphasize a core, language-mediated social disorder in patients with bvFTD. (shrink)

This article examines the role of context in the development and deployment of standards of medical decision-making. First, it demonstrates that bioethics, and our dominant standards of medical decision-making, developed out of a specific historical and philosophical environment that prioritized technology over the person, standardization over particularity, individuality over relationship and rationality over other forms of knowing. These forces de-contextualize the patient and encourage decision-making that conforms to the unnatural and contrived environment of the hospital. The article then explores several (...) important differences between the home health care and acute care settings. Finally, it argues that the personalized, embedded, relational and idiosyncratic nature of the home is actually a much more accurate reflection of the context in which real people make real decisions. Thus, we should work to “re-contextualize” patients, in order that they might be better equipped to make decisions that harmonize with their real lives. (shrink)

The principle of the child's right to an open future was first proposed by the legal philosopher Joel Feinberg and developed further by bioethicist Dena Davis. The principle holds that children possess a unique class of rights called rights in trust—rights that they cannot yet exercise, but which they will be able to exercise when they reach maturity. Parents should not, therefore, take actions that permanently foreclose on or pre-empt the future options of their children, but leave them the greatest (...) possible scope for exercising personal life choices in adulthood. Davis particularly applies the principle to genetic counselling, arguing that parents should not take deliberate steps to create physically abnormal children, and to religion, arguing that while parents are entitled to bring their children up in accordance with their own values, they are not entitled to inflict physical or mental harm, neither by omission nor commission. In this paper, I aim to elucidate the open future principle, and consider whether it is applicable to non-therapeutic circumcision of boys, whether performed for cultural/religious or for prophylactic/health reasons. I argue that the principle is highly applicable to non-therapeutic circumcision, and conclude that non-therapeutic circumcision would be a violation of the child's right to an open future, and thus objectionable from both an ethical and a human rights perspective. (shrink)

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While (...) this protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

Over the past two decades there has been a rapid expansion in our understanding of how human genetic variability impacts susceptibility and severity of disease. Through applications of genome-wide association studies, genome and exome sequencing, researchers have made thousands of discoveries of genetic variants that impact risk of common and rare disorders affecting millions of people. Although these techniques have been primarily applied to highly prevalent chronic disorders such as diabetes1 and cardiovascular disease2, infectious diseases have proven to not be (...) immune to genome-wide association, with studies of Tuberculosis3, HIV4 and SARS-CoV25, to name but a few, identifying host susceptibility loci across the genome. Unlike non-communicable diseases, infectious diseases have the unique element of impacting not only the affected the host, but those who may be most vulnerable to acquiring the infection. Thus, genetic variants that impact one individual’s susceptibility to and severity of an infection may also have broader implications to public health, as was brought into keen focus during the COVID-19 pandemic. Therefore, as we begin to apply the knowledge gained from genomic studies in the clinic or into policy, there are unique ethical, legal, and social implications (ELSI) at the intersection of infectious diseases and human genomics. In this issue of the Journal of Law, Medicine and Ethics, Jose et al attempt to address this need by proposing a research agenda for ELSI studies at what they term the “blurred boundaries” of infectious and genetic diseases.6. (shrink)

Where Medicine Went Wrong explores how the idea of an average value has been misapplied to medical phenomena, distorted understanding and lead to flawed medical ...

Thomasma and Pellegrino''s [3] focus on the healing relationship as the way to give medical ethics a philosophical foundation contains a number of difficulties. Most importantly, their approach focuses philosophical analysis on an idealized view of the healing relationship in which the ideal of health is seen as an uncontroversial norm in the individual case. medical ethics is then characterized as an intrinsic part of the medical act itself. Philosophical inquiry seems limited to a description of the practice of (...) medicine in which ethical norms are embodied. Insufficient attention to methodology leaves unclear how this vision is to be achieved in philosophical reflection. (shrink)

In this essay, we defend the design of the Salk polio vaccine trial and try to put some limits on the role schemata should play in designing clinical research studies. Our presentation is structured as a response to de Freitas and Pietrobon who identified the CONSORT statement as a schema that would have, had it existed at the time, ruled out the design of the Salk polio vaccine trial of 1954 in favor of a completely randomized controlled clinical trial. We (...) argue that large-scale public health interventions often require evidence beyond simple efficacy, the limit of what an RCT can provide, and that the design actually adopted for the Salk trial represented a reasonable—albeit imperfect—compromise. This is of more than historical interest in that many contemporary studies are of the scale and scope to require a more pragmatic, rather than explanatory, approach to study design. (shrink)

Global debates in approaches to HIV/AIDS control have recently moved away from a uniformly strong human rights-based focus. Public health utilitarianism has become increasingly important in shaping national and international policies. However, potentially contradictory imperatives may require reconciliation of individual reproductive and other human rights with public health objectives. Current reproductive health guidelines remain largely nonprescriptive on the advisability of pregnancy amongst HIV-positive couples, mainly relying on effective counselling to enable autonomous decision-making by clients. Yet, health (...) care provider values and attitudes may substantially impact on the effectiveness of nonprescriptive guidelines, particularly where social norms and stereotypes regarding childbearing are powerful, and where providers are subjected to dual loyalty pressures, with potentially adverse impacts on rights of service users. Data from a study of user experiences and perceptions of reproductive and HIV/AIDS services are used to illustrate a rights analysis of how reproductive health policy should integrate a rights perspective into the way services engage with HIV-positive persons and their reproductive choices. The analysis draws on recognised tools developed to evaluate health policies for their human rights impacts and on a model developed for health equity research in South Africa to argue for greater recognition of agency on the part of persons affected by HIV/AIDS in the development and content of policies on reproductive choices. We conclude by proposing strategies that are based upon a synergy between human rights and public health approaches to policy on reproductive health choices for persons with HIV/AIDS. (shrink)

This paper adopts a pragma-dialectic approach to explore inclusion in real-world argumentation. Having outlined theories of deliberative democracy—focussing on Habermas’s discourse model—and pragma-dialectic methods for analysing argumentative exchanges in the real world, we then relate them. From this we identify the potential for using the enhanced detail of pragma-dialectic analysis to constructively understand dynamics of inclusion in the political decision processes of central concern to deliberative democratic theories.In the remainder of the article we illustrate this potential with our own pragma-dialectic (...) analysis of an instance of real-world argumentation in a political policymaking process—a deliberative forum in the contentious field of mental health. The detail afforded by the pragma-dialectic method allows us to more clearly identify the complex layers and dynamics of argument involved in these policy deliberations, allowing insights into mechanisms for inclusion in deliberations, relative to the parties to such deliberations, their roles and competing interests and perspectives.By relating the two fields of deliberative democratic theory and pragma-dialectics this article aims to develop their complementary potential—in particular by suggesting, and briefly illustrating—how pragma-dialectic methods might enhance analysis of the dynamics of argumentation in political policymaking processes, in particular as an aid to constructive reflection on those processes by theorists and participants together. (shrink)

Artificial intelligence (AI) technologies in medicine are gradually changing biomedical research and patient care. High expectations and promises from novel AI applications aiming to positively impact society raise new ethical considerations for patients and caregivers who use these technologies. Based on a qualitative content analysis of semi-structured interviews and focus groups with healthcare professionals (HCPs), patients, and family members of patients with Parkinson’s Disease (PD), the present study investigates participant views on the comparative benefits and problems of using human versus (...) AI predictive computer vision health monitoring, as well as participants’ ethical concerns regarding these technologies. Participants presumed that AI monitoring would enhance information sharing and treatment, but voiced concerns about data ownership, data protection, commercialization of patient data, and privacy at home. They highlighted that privacy issues at home and data security issues are often linked and should be investigated together. Findings may help technologists, HCPs, and policymakers determine how to incorporate stakeholders’ intersecting but divergent concerns into developing and implementing AI PD monitoring tools. (shrink)

This study examines the way that consent is reported for participation in school-based research involving children or young people aged from 5 to 16 years. Databases containing descriptions of research identified during systematic reviews were surveyed to determine to what extent consent is sought, and from whom, and to see whether reporting varied by study characteristics such as the age of participants, the country in which the research was carried out, research design and substantive area of study. Of a total (...) of 489 studies in school settings involving children or young people, less than a third (n=145:30%) reported seeking consent. Only one in seven (n=66:13%) sought consent from children or young people themselves. Consent was reported significantly more frequently in studies sourced from health promotion reviews, when compared to those sourced from education reviews. Codes of practice indicate that researchers should seek consent from research participants. This study demonstrates that these principles are often not reflected in practice. (shrink)

Research shows that the physician’s personal attributes and social characteristics have a strong association with their end-of-life decision making. Despite efforts to increase patient, family and surrogate input into EOL decision making, research shows the physician’s input to be dominant. Our research finds that physician’s social values, independent of religiosity, have a significant association with physician’s tendency to withhold or withdraw life sustaining, EOL treatments. It is suggested that physicians employ personal social values in their EOL medical coping, because they (...) have to cope with existential dilemmas posed by the mystery of death, and left unresolved by medical decision making mechanisms such as advanced directives and hospital ethics committees. (shrink)

This article considers the various emergence of an explicitly recognized right to life in papal teaching and the canon law of the last century and a quarter. The Church's opposition to abortion is deeply embedded within the tradition and law of the Church. It was, however, only in recent times, since the middle twentieth century, really, that the Church began to speak explicitly of a right to life. This paper explores the consequences for papal thought of this explicit recognition of (...) rights. By speaking of a right to life, the Church has moved beyond the abortion debate to embrace a variety of other concerns. This is not to say that abortion does not remain important. Direct participation in abortion is a crime at canon law that results in automatic excommunication. But the language of rights has allowed the Church to address such matters as the protection of refugees; the moral requirement of adequate health care; the odious use of child-soldiers; and the use of economic embargoes that have the effect of destroying the civilian infrastructure (and public health systems) of entire societies. (shrink)

With this issue George Annas contributes his last At Law to the Hastings Center Report. Since the column was inaugurated in 1976 as Law and the Life Sciences, George has charted the course of biomedical ethics in the courts, challenging readers to come to grips with an emerging body of law in provocative analyses of critical decisions. As he retires from this column we wish him well, and look forward to his continued contributions to our pages. In bidding farewell to (...) one friend we are nonetheless pleased to welcome another as Alexander Morgan Capron, Henry W. Bruce University Professor of Law and Medicine at the University of Southern California and codirector of the Pacific Center for Health Policy and Ethics, joins the Report in the September‐October issue as a regular contributor to this column. Prof. Capron, formerly executive director of The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, is a distinguished scholar and writer well known to our readers. We welcome the opportunity to share his insights on issues before courts and legislatures nationwide. (shrink)

Recently, there have been discussions about whether or not inter-collegiate football should be eliminated in the US. This article philosophically assesses the arguments for its elimination as well as the arguments proffered against its elimination. While a variety of arguments are discussed, a new one is brought into the foray of philosophical investigation, one that combines the unfairness and economic arguments: the health care and medical costs to others argument. It is believed that this argument is sufficient to justify (...) the elimination of inter-collegiate football. (shrink)

Next SectionCultural differences in end-of-life care and the moral disagreements these sometimes give rise to have been well documented. Even so, cultural considerations relevant to end-of-life care remain poorly understood, poorly guided, and poorly resourced in health care domains. Although there has been a strong emphasis in recent years on making policy commitments to patient-centred care and respecting patient choices, persons whose minority cultural worldviews do not fit with the worldviews supported by the conventional principles of western bioethics face (...) a perpetual struggle in getting their care needs met in a meaningful, safe, and healing way. In this essay, attention is given to exploring why cultural differences exist, why they matter, and how health care providers should treat them in order to reduce the incidence and impact of otherwise preventable harmful moral outcomes in end-of-life care. In addressing these questions, a novel application of the renowned terror management theory will be made. (shrink)

Traditional welfare states were based on passive solidarity. Able bodied, healthy minded citizens paid taxes and social premiums, usually according to a progressive taxation logic following the ability to pay principle. Elderly, fragile, weak, unhealthy and disabled citizens were taken care of in institutions, usually in quiet parts of the country. During the nineteen eighties and nineties of the twentieth century, ideas changed. Professionals, patients and policy makers felt that it would be better for the weak and fragile to live (...) in mainstream society, rather than be taken care of in institutions outside society. This might be cheaper too. Hence policy measures were taken to accomplish deinstitutionalization. This article discusses the implications of deinstitutionalization for distributive justice. It is argued that the weakest among the weak and fragile stand to lose from this operation. For able bodied citizens deinstitutionalization entails a move from passive to active solidarity. Rather than just pay taxes they have to actively care for and help the needy themselves. The move from passive to active solidarity tends to take advantage of benevolent citizens and burden the socioeconomically disadvantaged. This may be a reason to reconsider the policy move toward deinstitutionalization. (shrink)

John O’Neill, Alan Holland, and Andrew Light usefully distinguish two ways of thinking about environmental values, namely, end-state and historical views. To value nature in an end-state way is to value it because it instantiates certain properties, such as complexity or diversity. In contrast, a historical view says that nature’s value is (partly) determined by its particular history. Three contemporary defenses of a historical view are explored in order to clarify: (1) the normatively relevant history; (2) how historical considerations are (...) supposed to instruct environmental decision making; and (3) the relative importance of historical and end-state considerations. There are multiple reasons for including historical considerations in an account of environmental values. For example, knowledge of a natural object’s history can add depth and texture to our appreciation of that object. Further, if we were blind to the relevant history, we could not adequately understand and defend environmental policy goals such as preserving the potentials of natural systems or maintaining ecological health, for these goals appear to have irreducibly historical aspects. While historical considerations are important, such considerations are insufficient to guide our normative thinking about nature and how it should be dealt with practically. But they succeed in broadening and deepening our understanding of the nature and sources of environmental value. (shrink)

Volunteering, or taking part in unpaid work for the benefit of others, can be a powerful positive experience with returns to both individual well-being and community projects. Volunteering is positively associated with mental health in observational studies with community samples but has not been systematically examined as a potential part of treatment interventions with clinical adolescent samples. In this manuscript, we review the empirical evidence base connecting volunteerism to mental health and well-being, outline potential mechanisms based in the (...) theoretical literature from developmental science, and discuss the existing clinical approaches that support community volunteering as a part of treatment. Drawing on this review, we propose that including volunteering as a component of clinical treatment approaches for adolescent depression can be a powerful intervention for adolescents. (shrink)

Recent research on the evolution of religion has focused on whether religion is an unselected by-product of evolutionary processes or if it is instead an adaptation by natural selection. Adaptive hypotheses for religion include direct fitness benefits from improved health and indirect fitness benefits mediated by costly signals and/or cultural group selection. Herein, I propose that religious denominations achieve indirect fitness gains for members through the use of ecologically arbitrary beliefs, rituals, and moral rules that function as recognition markers (...) of cultural inheritance analogous to kin and species recognition of genetic inheritance in biology. This recognition signal hypotheses could act in concert with either costly signaling or cultural group selection to produce evolutionarily altruistic behaviors within denominations. Using a cultural phylogenetic analysis, I show that a large set of religious behaviors among extant Christian denominations supports the prediction of the recognition signal hypothesis that characters change more frequently near historical schisms. By incorporating demographic data into the model, I show that more-distinctive denominations, as measured through dissimilar characteristics, appear to be protected from intrusion by nonmembers in mixed-denomination households, and that they may be experiencing greater biological growth of their populations even in the present day. (shrink)

Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forego Medical Treatment. The guidelines deal with four specific decision-making circumstances: 1. Five guidelines were created for decisions involving competent patients or patients who have executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not (...) now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom 'no substituted judgement' can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities, given the reality of scarce health resources (1). The term 'physician' is used in the American sense, synonymous with 'medical practitioner'. (shrink)

BackgroundResuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit, meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people regarding resource allocation decisions in the NICU.MethodsThe study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were (...) 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing.ResultsThe majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival, life expectancy, and cost of treatment. In the classic ‘lifeboat’ scenario, all but two respondents were utilitarian.ConclusionsThis survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment. (shrink)

In a recent issue of Journal of Medical Ethics (JME), we discussed the ethical review of evaluations of interventions that would occur whether or not the evaluation was taking place. We concluded that standard research ethics frameworks including the Ottawa Statement, which requires justification for all aspects of an intervention and its roll-out, were a poor guide in this area. We proposed that a consideration of researcher responsibility, based on the consequences of the research taking place, would be a more (...) appropriate way delineate the scope of research ethics review. Weijer and Taljaard present a counterargument to our proposal, which we address in this reply. They claim that a focus on researcher responsibility will weaken the protection of research participants and link it to ‘unethical research’ and a ‘government experimenting on its own people’. However, the moral responsibility of researchers is defined in terms of the consequences of the research on human welfare and harm, not in opposition to it. Weijer and Taljaard argue that researchers must justify what they are studying whether or not they have any control over it and that governments must justify their programmes, including by demonstrating equipoise, to a research ethics committee if they implement them in a randomised way. We strongly disagree that this is a defensible way to define the scope of research ethics review and argue that this provides no further protections to research participants beyond what we propose, but places a potential barrier to learning from government programmes. (shrink)

Rita Charon says that narrative medicine is about honoring stories of illness. In a system where physicians and patients can often feel as though they are reduced to numbers, narrative medicine is a plea to take the narratives of illness seriously. But what does it mean to honor a story? In this essay, I use the framework of narrative medicine to offer narrative reflections on the concept of honor inspired by on three definitions, including respect, moral rightness, and high regard. (...) I explain how each definition illustrates an aspect of honor and its role as an ethical virtue in narrative medicine. (shrink)