In this letter to the editor, the author responds to articles by G. Testa and colleagues, "Living Donation and Cosmetic Surgery: A Double Standard in Medical Ethics?" and by L. Friedman Ross and colleagues, "Different Standards Are Not Double Standards: All Elective Surgery Patients Are Not Alike," which were published in the Summer 2012 issue of The Journal of Clinical Ethics.

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

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

Under the impressive editorship of Warren Samuels et al, this book addresses the state of the history of economic thought today. An important contribution to the study of the history of economics, this eagerly-awaited book will develop an unsurprisingly large following.

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

BackgroundChildhood adversity is linked to adverse health in adulthood. One posited mechanistic pathway is through physiological responses to acute stress. Childhood adversity has been previously related to both exaggerated and blunted physiological responses to acute stress, however, less is known about the psychological mechanisms which may contribute to patterns of physiological reactivity linked to childhood adversity.ObjectiveIn the current work, we investigated the role of challenge and threat stress appraisals in explaining relationships between childhood adversity and cortisol reactivity in response to (...) an acute stressor.MethodsUndergraduate students completed an online survey that included general demographic information and the Risky Families Questionnaire 24 h before a scheduled lab visit. In the lab, a research assistant collected a baseline salivary cortisol sample. Following the baseline period, participants were read instructions for the Trier Social Stress Test, a validated psychological lab stressor. Next, they completed a challenge vs. threat task appraisal questionnaire and completed the speech and math portion of the TSST. Twenty minutes following the start of the TSST, a second salivary sample was collected to measure changes in salivary cortisol following the TSST.ResultsLinear regression analyses adjusted for age, sex, childhood socioeconomic status, and baseline cortisol levels, showed childhood adversity associated with changes in cortisol levels [B = –0.29 t = –2.35, p = 0.02, R2=0.07]. Linear regression analyses controlling for age, sex, and childhood SES showed childhood adversity associated with both challenge [B = –0.52 t = –5.04, p < 0.001, R2=0.24] and threat [B = 0.55 t = 5.40, p < 0.001, R2=0.27] appraisals. Significant indirect effects of childhood trauma on cortisol reactivity were observed through challenge appraisals [B = –0.01 ], and threat appraisals [B = –0.01 ].ConclusionChildhood adversity may contribute to blunted cortisol reactivity, a pattern of response which is linked to obesity, addiction, and other behavior-related diseases. Our findings suggest that this relationship is in part a product of stress appraisals. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

About 6,000 individuals participate in the U.S. transplant system as a living organ donor each year. Organ donation by living individuals is a unique procedure, where healthy patients undergo a major surgical operation without any direct functional benefit to themselves. In this article, the authors explore how the ideal of informed consent guides education and evaluation for living organ donation. The authors posit that informed consent for living organ donation is a process. Though the steps in this process are partially (...) standardized through national health policy, they can be improved through institutional structures at the local, transplant center-level. Effective structures and practices aimed at supporting and promoting comprehensive informed consent provide more opportunities for candidates to ask questions about the risks and benefits of living donation and to opt out voluntarily Additionally, these practices could enable new ways of measuring knowledge and improving the consent process. (shrink)

Volume 19, Issue 11, November 2019, Page 42-44.

J. Angelo Corlett’s response to Leigh Turner defends the current practice of anonymous refereeing in scholarly journals. In reply to him: a slightly refined proposal for signed referees’ reports, with temporarily blind refereeing, would restore to the process of publication, in philosophy at least, the sense of responsibility for rational debate, cooperation, mutual criticism, and simple courtesy which is expected among colleagues in public academic relations, and would also allow more credit for the difficult task for refereeing. Personal observation (...) of the quality of referees’ reports suggests that a gathering of anecdotal evidence would show the need for reform. (shrink)

As computer-based information systems start to have a great impact on people, organizations, and society as a whole, there is much debate about information technology in relation to social control and privacy, security and reliability, and ethics and professional responsibilities. However, more often than not, these debates reveal some fundamental disagreements, sometimes about first principles. In this article the authors suggest that a fruitful and interesting way to conceptualize some of these moral and ethical issues associated with the use of (...) information technology is to apply the principles of Aristotle's ethics to this topic. They argue that framing the moral and ethical choices associated with information technology in Aristotelian terms draws attention to the fact that there are fundamental dilemmas to be addressed. These dilemmas are discussed in relation to the four areas suggested by Dejoie, Fowler, and Paradice (1991): (a) privacy, (b) information accuracy, (c) access to information, and (d) intellectual property rights. The dilemmas associated with all four areas are illustrated with references to recent legal developments in Australia and New Zealand. (shrink)

Part I examines various readings about which there persists editorial or other disagreement, Part II argues that six couplets are not from Ovid's hand. The lemmata give the reading of the Oxford Classical Text, followed by the rejected variants and any conjectures. ‘Goold’ = G. P. Goold, ‘Amatoria Critica’, HSCP 69, 1–107. ‘Geisler’ = H. J. Geisler, P. Ovidius Naso Rentedia Amoris mit Kommentar zu Vers 1–396. Normally only the principal manuscripts are cited individually.

Accounts of theistic faith according to which it does not involve referring to or believing in God as existing independently of the life of faith are instances of theistic reductionism. Theistic reductionism, in holding that ‘God’ does not refer to reality outside the life of believers, holds thereby that theism is not rightly to be regarded as true or false. Such accounts may be proposed or used as defenses of theistic faith. They ‘defend’ faith insofar as they describe the form (...) of life faith involves and show that the human and cultural functions it performs are valuable. Examining several reductionist accounts, ordered from weaker to stronger, I argue that they fail as defenses of theistic life and language. Whereas the reductionist views claim to leave the practice of theism as it is, I argue that in fact they imply a different form of life from the one theism actually is. Thus reductionist defenses of religious practice fail and fail precisely where they insist on treating God in some way other than as existing outside of religious life. From this I infer that theism as it exists can only be defended in ways that include taking ‘God’ as referring to a God who is real outside the life which recognizes him. The religious reductionists discussed include R.B. Braithwaite, P.F. Schmidt, Paul Holmer, Paul van Buren, Gordon Kaufman, and D.Z. Phillips. (shrink)

Australia is currently experiencing a prolonged period of water scarcity that is challenging a diverse range of water-dependent activities ranging from household gardening to horticultural production to the viability of riverine ecosystems. The political and ecological importance of water in Australia is not, however, only a recent phenomenon. For the majority of Australia’s settled history, water politics, economics, culture and engineering have reflected and embodied a dynamic relationship between Australian hydrology and Australian society. This essay examines that relationship by first (...) reviewing the work of the Australian historical geographer, Emeritus Professor J. M. Powell. For 40 years Powell has been writing about the process of natural resource appraisal and management in Australia and he has been Australia’s leading authority on the role of water in that process for most of that time. The essay then argues for an extension of Powell’s work by applying the insights provided by the scholars Karl Wittfogel, Donald Worster and Eric Swyngedouw. Their work, it is argued, suggests the possibility of a more nuanced understanding of water in Australia than that currently offered by the majority of the Australian literature, and ultimately provides some tools for thinking ourselves out of the current water crisis. (shrink)

We present five experiments and simulation studies to establish late analogical abstraction as a new psychological phenomenon: Schema abstraction from analogical examples can revive otherwise inert knowledge. We find that comparing two analogous examples of negotiations at recall time promotes retrieving analogical matches stored in memory—a notoriously elusive effect. Another innovation in this research is that we show parallel effects for real‐life autobiographical memory (Experiments 1–3) and for a controlled memory set (Experiments 4 and 5). Simulation studies show that a (...) unified model based on schema abstraction can capture backward (retrieval) effects as well as forward (transfer) effects. (shrink)

Ranchers and pastoralists worldwide manage and depend upon resources from rangelands across Earth’s terrestrial surface. In the Great Plains of North America rangeland ecology has increasingly recognized the importance of managing rangeland vegetation heterogeneity to address conservation and production goals. This paradigm, however, has limited application for ranchers as they manage extensive beef production operations under high levels of social-ecological complexity and uncertainty. We draw on the ethics of care theoretical framework to explore how ranchers choose management actions. We used (...) modified grounded theory analysis of repeated interviews with ranchers to compare rancher decision-making under relatively certain and uncertain conditions and describe a typology of practices used to prioritize and choose management actions that maintain effective stewardship of these often multi-generational ranches. We contrast traditional decision-making frameworks with those described by interviewees when high levels of environmental and market uncertainty or ecological complexity led ranchers toward use of care-based, flexible and relational frameworks for decision-making. Ranchers facing complexity and uncertainty often sought “middle-ground” strategies to balance multiple, conflicting responsibilities in rangeland social-ecological systems. For example, ranchers’ care-based decision-making leads to conservative stocking approaches to “manage for the middle,” e.g. to limit risk under uncertain weather and forage availability conditions. Efforts to promote heterogeneity-based rangeland management for biodiversity conservation through the restoration of patch burn grazing and prairie dog conservation will require increased valuation of ranchers’ care work. (shrink)

A key philosophical feature of Peter Jackson’s film interpretation of J.R.R. Tolkien’s The Lord of the Rings is its use of fantasy to inspire a “recovery” of the actual or, in other words, a reawakening to the beauty of nature and the many possible ways of living in healthier ecological relation to the world. Though none of these ways is perfectly achieved, this pluralistic view is demonstrated in the various lifeways of Hobbits, Elves, Men, and Ents. All of the positive (...) relationships embodied in the films—to trees, mountains, horses, and vegetable gardens—involve loving care and attention, receiving nourishment and livelihood without instrumentalization, or reducing nature to mere resource. The films also vividly display a variety of ugly and destructive ways of using the land to accrue power and wealth. These noxious ways, specifically because they actively destroy the lands that they use, always need more. They will thus eventually annihilate the beautiful ways of being if they are not actively resisted. Some of those who would rather be tending their own trees, gardens, or horses or even wandering in the wild forests must therefore turn their attention to struggle and resistance instead. This is a struggle full of grief, and at times even verging on despair, but it is marked by the refusal to give up hope. Indeed, what Jackson and Tolkien have to say about hope is as important in responding to the ecological crisis as anything they have to say about nature, inasmuch as they help to remind us that even in our own times, “there is still hope.”. (shrink)

Mixed results regarding the role of gender in moral reasoning prompted an investigation of an alternative characteristic that may be more influential in the process: sex role orientation. We present an empirical assessment of the relationship between an individual’s moral reasoning level and his/her sex role orientation, gender, and several academic factors. Our results indicate that sex role orientation is not related to moral reasoning level. Gender is related to moral reasoning in our study, women reasoning at higher levels than (...) men. We found a positive relationship between education and moral reasoning level, and moral reasoning levels differed across academic institutions. Our results also show business students have lower moral reasoning levels than students in other fields, although this result did not reach statistical significance. (shrink)

We develop an untyped framework for the multiverse of set theory. $\mathsf {ZF}$ is extended with semantically motivated axioms utilizing the new symbols $\mathsf {Uni}(\mathcal {U})$ and $\mathsf {Mod}(\mathcal {U, \sigma })$, expressing that $\mathcal {U}$ is a universe and that $\sigma $ is true in the universe $\mathcal {U}$, respectively. Here $\sigma $ ranges over the augmented language, leading to liar-style phenomena that are analyzed. The framework is both compatible with a broad range of multiverse conceptions and suggests its (...) own philosophically and semantically motivated multiverse principles. In particular, the framework is closely linked with a deductive rule of Necessitation expressing that the multiverse theory can only prove statements that it also proves to hold in all universes. We argue that this may be philosophically thought of as a Copernican principle that the background theory does not hold a privileged position over the theories of its internal universes. Our main mathematical result is a lemma encapsulating a technique for locally interpreting a wide variety of extensions of our basic framework in more familiar theories. We apply this to show, for a range of such semantically motivated extensions, that their consistency strength is at most slightly above that of the base theory $\mathsf {ZF}$, and thus not seriously limiting to the diversity of the set-theoretic multiverse. We end with case studies applying the framework to two multiverse conceptions of set theory: arithmetic absoluteness and Joel D. Hamkins’ multiverse theory. (shrink)

This paper presents a novel proof of the conservativity of the intuitionistic theory of strictly positive fixpoints, $$\widehat{{\textrm{ID}}}{}_{1}^{{\textrm{i}}}{}$$ ID ^ 1 i, over Heyting arithmetic ($${\textrm{HA}}$$ HA ), originally proved in full generality by Arai (Ann Pure Appl Log 162:807–815, 2011. https://doi.org/10.1016/j.apal.2011.03.002). The proof embeds $$\widehat{{\textrm{ID}}}{}_{1}^{{\textrm{i}}}{}$$ ID ^ 1 i into the corresponding theory over Beeson’s logic of partial terms and then uses two consecutive interpretations, a realizability interpretation of this theory into the subtheory generated by almost negative fixpoints, and (...) a direct interpretation into Heyting arithmetic with partial terms using a hierarchy of satisfaction predicates for almost negative formulae. It concludes by applying van den Berg and van Slooten’s result (Indag Math 29:260–275, 2018. https://doi.org/10.1016/j.indag.2017.07.009) that Heyting arithmetic with partial terms plus the schema of self realizability for arithmetic formulae is conservative over $${\textrm{HA}}$$ HA. (shrink)