Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Experience with electronic communication in ethics committees at two hospitals is reviewed and discussed. A listserver of ethics committee members transmitted a synopsis of the ethics consultation shortly after the consultation was initiated. Committee comments were sometimes incorporated into the recommendations. This input proved to be most useful in unusual cases where additional, diverse inputs were informative. Efforts to ensure confidentiality are vital to this approach. They include not naming the patient in the e-mail, requiring a password for access to (...) the listserver, and possibly encryption. How this electronic communication process alters group interactions in ethics committees is a fruitful area for future investigation. (shrink)

On page 1 of his classic text, Millsap states, “Measurement invariance is built on the notion that a measuring device should function the same way across varied conditions, so long as those varied conditions are irrelevant [emphasis added] to the attribute being measured.” By construction, measurement invariance techniques require not only detecting varied conditions but also ruling out that these conditions inform our understanding of measured domains. In fact, measurement invariance techniques possess great utility when theory and research inform their (...) application to specific, varied conditions that, if not detected, introduce measurement biases, and, thus, depress measurement validity. Yet, we see emerging bodies of work where scholars have “put the cart before the horse” when it comes to measurement invariance, and they apply these techniques to varied conditions that, in fact, may reflect domain-relevant information. These bodies of work highlight a larger problem in measurement that likely cuts across many areas of scholarship. In one such area, youth mental health, researchers commonly encounter a set of conditions that nullify the use of measurement invariance, namely discrepancies between survey reports completed by multiple informants, such as parents, teachers, and youth themselves. In this paper, we provide an overview of conceptual, methodological, and measurement factors that should prevent researchers from applying measurement invariance techniques to detect informant discrepancies. Along the way, we cite evidence from the last 15 years indicating that informant discrepancies reflect domain-relevant information. We also apply this evidence to recent uses of measurement invariance techniques in youth mental health. Based on prior evidence, we highlight the implications of applying these techniques to multi-informant data, when the informant discrepancies observed within these data might reflect domain-relevant information. We close by calling for a moratorium on applying measurement invariance techniques to detect informant discrepancies in youth mental health assessments. In doing so, we describe how the state of the science would need to fundamentally “flip” to justify applying these techniques to detect informant discrepancies in this area of work. (shrink)

Bioethical dilemmas can emerge in research and clinical settings, from end-of-life decision-making to experimental therapies. The COVID-19 pandemic raised serious ethical challenges for healthcare organizations, highlighting the need to conduct needs assessments of the bioethics infrastructures of healthcare organizations. Clinical ethics committees (CECs) also create equitable policies, train staff on ethics issues, and play a consultative role in resolving the difficulty of complex individual cases. The main objective of this project was to conduct a needs assessment of the bioethics infrastructure (...) within a comprehensive hospital system. A cross-sectional anonymous online survey, including quantitative and qualitative formatted questions. The survey was sent to five key leaders from the organization’s hospitals. Survey questions focused on the composition, structure, function, and effectiveness of their facilities’ bioethics infrastructure and ethics-related training and resources. Positive findings included that most facilities have active CECs with multidisciplinary membership; CECs address critical issues and encourage team members to express clinical ethics concerns. Areas of concern included uncertainty about how CECs function and the process for resolving clinical ethics dilemmas. Most reported no formal orientation process for CEC members, and many said there was no ongoing ethics education process. The authors conclude that if CECs are a critical institutional resource where the practice of medicine and mission intersect, having well-functioning ethics committees with trained and oriented members demonstrates an essential commitment to the mission. The survey revealed that more needs to be done to bolster the bioethics infrastructure of this institution. (shrink)

In The Global Financial Crisis, contributors argue that the complexity of the Global Financial Crisis challenges researchers to offer more comprehensive explanations by extending the scope and range of their traditional investigations.

The HealthyFood program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. Members receiving the lowest cash back level were randomized to one of six arms: Arm 1 : 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, (...) personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean difference in percent healthy spending was between Arm 1 and Arm 2, and the largest mean difference in percent unhealthy spending was also between Arm 1 and Arm 2, but no differences were statistically significant after correction for multiple comparisons. None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. (shrink)

ObjectiveHead and neck cancer treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: the prevalence, level, and course of body image concerns; correlates of upon cancer diagnosis body image concerns; predictors of immediate post-treatment body image concerns; and association between body image concerns (...) and levels of anxiety, depression, suicidal ideation, support, and alcohol and drug misuse.MethodsTwo hundred and twenty-three, newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model.ResultsSixty-eight percent of patients with HNC presented some level of body image concerns. Body image concerns at baseline and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment, 89% presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism.ConclusionThis longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions. (shrink)

"In this concluding volume of his impressive study of the history of Western thought about the nature of love, Irving Singer reviews the principal efforts that have been made by 20th-Century thinkers to analyze the phenomenon of love.... [T]he bulk of the book is taken up with critical accounts of the modern thinkers who have systematically called into question the possibility itself of love as a union of distinct human selves. For the most part, these critiques are effectively executed, and (...) they bring a high level of critical acumen to bear on skeptical theses about love that are now too often accepted as truisms."—Frederick A. Olafson, _Los Angeles Times Book Review_ "Irving Singer... has developed a method of historical analysis flexible enough to deal with all kinds of love, from Greek homosexual love in Plato, to the _philia_ and _agape_ of the New Testament, to the courtly love of medieval romance, to the Romantics, for whom love was magic.... [This] final volume brings us to the present. In 'The Modern World,' Singer offers readings of Freud, Proust, and Sartre, among others. He shows how their work was formed in reaction to the 19th-century ideal of 'merging' of the identities of lover and beloved. More often than not, the great modern writers portray love as impossible, as a field of failure and regret.... This masterpiece of critical thinking is a timely, eloquent, and scrupulous account of what, after all, still makes the world go round."—Thomas D'Evelyn, _Christian Science Monitor_ "This is the third of a three-volume history of the philosophy of love. It begins with Kierkegaard, Tolstoy, and Nietzsche in the nineteenth century and treats Freud, Proust, Bergson, D. H. Lawrence, G. B. Shaw, Santayana, Sartre, and others in the twentieth. Although the author's approach is primarily historical, he intersperses critical remarks throughout. Most of the major themes which are discussed by philosophers of love make their way into this history, including friendship, sexual love, and the distinction between love that is based on the value of the beloved and love that bestows value on the beloved. Singer devotes a number of pages to his own views on falling in love, being in love, and staying in love.... Singer's exposition is lucid and organized; his criticisms are insightful."—_Ethics_ "In this third volume of historical overview of the development of the Western conception of love, Singer uses writers, philosophers, and psychologists to provide the reader with an overview of love in the late 19th and 20th century.... Analyzing authors such as Tolstoy, Proust, D. H. Lawrence, and Shaw and philosophers such as Nietzsche, Kierkegaard, Sartre, and Santayana, as well as Freud, Singer... links each contributor's thoughts to the influence of previous writers and also provides some psycho-historical insight into their personal lives that might have been either a source or direct result of their views. In this final volume, Singer proceeds to look at not just the 'great men' influence but also provides a chapter overviewing scientific contributions to our understanding of love.... Singer's work is a significant contribution to understanding the social construction of important, abstract social and personal values. By tracing love through different historical periods through a variety of voices, Singer has created a rich history of the struggle between the ideal and the real, between the dreams of what love should provide and the reality of what relationships have been in each historical period. By personalizing the voice through psychohistorical analysis, Singer also provides insight into the shaping of ideas through the intimate struggles of the shapers."—Mark V. Chaffee, _Contemporary Psychology_. (shrink)

Background Our objective was to evaluate whether the description of a machine learning (ML) app or brain imaging technology to predict the onset of schizophrenia or alcohol use disorder (AUD) influences healthcare professionals’ judgments of stigma, empathy, and compassion. Methods We randomized healthcare professionals (N = 310) to one vignette about a person whose clinician seeks to predict schizophrenia or an AUD, using a ML app, brain imaging, or a psychosocial assessment. Participants used scales to measure their judgments of stigma, (...) empathy, and compassion. Results Participants randomized to the ML vignette endorsed less anger and more fear relative to the psychosocial vignette, and the brain imaging vignette elicited higher pity ratings. The brain imaging and ML vignettes evoked lower personal responsibility judgments compared to the psychosocial vignette. Physicians and nurses reported less empathy than clinical psychologists. Conclusions The use of predictive technologies may reinforce essentialist views about mental health and substance use that may increase specific aspects of stigma and reduce others. (shrink)

It can be easy to assume that since the “theist in the street” is unaware of any of the traditional arguments for theism, he or she is not in position to offer independent rational support for believing that God exists. I argue that that is false if we accept with William Alston that “manifestation beliefs” can enjoy rational support on the basis of suitable religious experiences. I make my case by defending the viability of a Moorean-style proof for theism—a proof (...) for the existence of God that parallels in structure G. E. Moore’s famous proof for the existence of the external world. I argue that this shows that even if the theist in the street has nothing to offer for helping to convince the religious sceptic, this needn’t entail that she cannot offer independent rational support in defense of her theistic belief. (shrink)

A growing number of theorists have launched an epistemic challenge against retributive punishment. This challenge involves the core claim that it is wrong (intentionally) to inflict serious harm on someone unless the moral argument for doing so has been established to a high standard of credibility. Proponents of this challenge typically argue that retributivism fails to meet the required epistemic standard, because retributivism relies on a contentious conception of free will, about whose existence we cannot be sufficiently certain. However, the (...) scope of the epistemic challenge should not be limited to doubts about free will or retributivism. In this article, I argue that the epistemic challenge should be expanded beyond the original focus on justifications of punishment. By “expanding the epistemic challenge” I mean demanding that other purported justifications for serious (intentional) harm be held to a high standard of credibility. To provide a focus for the argument, I will concentrate on the “Public Health Quarantine Model” defended by Gregg Caruso, but my arguments have wider implications beyond this model. A growing number of “abolitionist” theorists believe that punishment is wrong in principle. If retributive punishment, or punishment in general, were abandoned, we would need to ask, “how else should we respond to crime?”. My arguments suggest that all such abolitionists will have to face the same epistemic standard as penal theorists if they wish to replace punishment with the intentional imposition of non-punitive severe coercive measures. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

This Element critically surveys the full range of G. E. Moore's ethical thought, including: his rejection of naturalism in favor of the view that 'good' designates a simple, indefinable property, which cannot be identified with or reduced to any other property; his understanding of intrinsic value, his doctrine of organic wholes, his repudiation of hedonism, and his substantive account of the most important goods and evils; and his critique of egoism and subjectivism and his elaboration of a non-hedonistic variant of (...) utilitarianism that, among other things, creatively blends aspects of act- and rule-oriented versions of that theory. (shrink)

Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the (...) range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and tim.. (shrink)

In this late modern era within which the basic values of life have been reordered (driven by globalisation, the corporate agenda and mass communication technologies), the individual has effectively been reduced to a mere abstraction. It might be argued that the rational, moral and humanistic concept of freedom has, to a great extent, been compromised by a consequent crisis within the intelligentsia. These groups, in particular the gatekeepers of a classical liberal approach to legal scholarship, are caught between the twin (...) evils of increased unreflective populism and pragmatism evident within many law schools and modern legal institutions. Although a contested term, defenders of the ‘socio-legal’ tradition, who place the humanities at the heart of legal research and education, are obliged to restate with increased determination the utility of the liberal arts and literature to the law profession and wider legal community. In a normative environment, law and narrative are inextricably linked and narrative poetry is not only invaluable to explaining the origins and location of the legal tradition, but also elicits a mode of understanding which transcends the boundaries of narrowlydefined legal hermeneutics—which often only addresses issues of an operational nature. French novelist Flaubert claimed “chaque notaire porte en soi les débris d’un poète” (Flaubert in Madame bovary (trans: Wall, G.), Penguin Classics, London, 1960: 269), paraphrased by American civil rights lawyer, Clarence Darrow, as “inside every lawyer is the wreck of a poet” (Lukas in Big trouble: a murder in a small western town sets off a struggle for the soul of America, Simon & Schuster, New York, 1997: 323). In an age of disenchantment, this paper explores the poetic form as an important medium within which to understand the nature and function of law in a society of differentiated individuals. (shrink)

. All personal that belong to a company, has to be consider into their daily agenda theoptimization of the inventory, in matter of create a cost reduction into the organization, an finallyincrement the productivity.The inventory is the element that gives “live” to the companies, in the moment to be manufacturedinto a product, through the works stations, is the case, that the excess of inventory will force thecompany not invert into development, research, training, technology, etc., and this situation willaffect competiveness, and (...) take the risk of be out of the market.The clients pay for a good, with a competitiveness price, excellent quality, and complete all thespecification that they request, plus has to be deliver on time; our responsibility is do wherever ittakes to guaranty the mayor percentage of efficiency in all our process and complete the goal ofsatisfy our clients.Keywords. Competitiveness, cost, inventory management, productivity.Resumen. Todo el personal estratégico, administrativo y operativo perteneciente a una empresa,debe considerar dentro de su agenda diaria la optimización de la gestión de los inventarios,permitiendo con ello un impacto en la reducción los costos de la organización, que se traducirá en unincremento de la productividad.El inventario es el elemento que permite dar vida a las empresas, al momento de ser transformada enun producto, a través de todas las estaciones de trabajo dando paso a paso un valor agregado, sinembargo el exceso de los inventarios ocasiona que la organización no pueda en incurrir en gastos quepermitan el desarrollo y crecimiento, como son las áreas de investigación y desarrollo, capacitación yadiestramiento, tecnología, mercadotecnia, etc., trayendo en consecuencia perder el nivel decompetitividad, y con ello correr el riesgo de quedar desplazado por la competencia.Los clientes pagan por producto que presente un precio competitivo; de la más alta calidad; quecumpla con todas y cada una de sus especificaciones; que sea entregado en tiempo y forma; esnuestra responsabilidad como estrategas, administradores y operadores de los inventarios, elgarantizar el mayor porcentaje de eficiencia en los procesos productivos y administrativos, demanera de lograr el fin último de toda empresa tiene, satisfacer a sus clientes.Palabras claves. Administración de inventarios, competitividad, costos, productividad. (shrink)

The Pareto argument for inequality holds that any change from a position of equality to one of inequality is justified so long as everyone benefits from the change. G.A. Cohen criticizes this argument (which he attributes to Rawls) on the ground that changes can normally be found which preserve both equality and Pareto‐efficiency. However, this does not resolve the basic conflict between the two desiderata. Strong egalitarians hold that Pareto changes are not for the better if they increase inequality too (...) greatly. Thus if the Pareto argument holds, then strong egalitarianism is unsustainable. I argue that egalitarians need not be troubled by the Pareto argument for inequality. The Pareto criterion would not be widely accepted unless it takes account of moral harms; but if it does take account of moral harms then there is no reason to doubt that egalitarian concerns can be incorporated into the Pareto argument. (shrink)