This paper reviews the concept of professional autonomy from anhistorical perspective. It became formalised in the United Kingdom onlyafter a long struggle throughout most of the nineteenth century. In itspure form professional autonomy implies unlimited powers to undertakemedical investigations and to prescribe treatment, irrespective of cost.Doctors alone should determine the quality of care and the levels ofremuneration to which they should be entitled. In the second half of thetwentieth century a steady erosion of professional autonomy occurred inthe United Kingdom. The (...) level of remuneration has been restricted formost doctors for nearly fifty years, whilst the costs of health carehave steadily reduced the doctor's ability to provide unrestricted carewithin the health care system. Reorganisation of the National HealthService in 1983 and 1991 has substantially eroded professional autonomy,to the point where research developments, clinical judgement and ethicalstandards are all now being placed at risk. (shrink)

This paper applies theory and research examining errors in complex organizational systems to the problem of individual and collective morality in organizations. It is proposed that because of the nature of complex organizations, unjust outcomes can (and will) result from organizational actions even when all organization members have acted responsibly. The argument that complex organizations are therefore immoral is considered and rejected. Instead, the paper argues that morality in complex organizations begins with "heedful interrelating" among individual organization members. The paper (...) concludes with a discussion of organizational processes and structures that promote heedful interrelating. (shrink)

Background: Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers. Aim: This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits. Research design: The Birth Unit Design project was a 2012 Australian ethnographic study that used video recording to investigate the physical design features in the hospital birthing space that might influence both verbal and non-verbal (...) communication and the experiences of childbearing women, midwives and supporters. Participants and research context: Six women, 11 midwives and 11 childbirth supporters were filmed during the women’s labours in hospital birth units and interviewed 6 weeks later. Ethical considerations: The study was approved by an Australian Health Research Ethics Committee after a protracted process of negotiation. Findings: The ethics committee was influenced by a traditional view of research as based on scientific experiments resulting in a poor understanding of video-ethnographic research, a paradigmatic view of the politics and practicalities of modern childbirth processes, a desire to protect institutions from litigation, and what we perceived as a paternalistic approach towards protecting participants, one that was at odds with our aim to facilitate situations in which women could make flexible, autonomous decisions about how they might engage with the research process. Discussion: The perceived need for protection was overly burdensome and against the wishes of the participants themselves; ultimately, this limited the capacity of the study to improve care for women and babies. Conclusion: Recommendations are offered for those involved in ethical approval processes for qualitative research in childbirth settings. The complexity of issues within childbirth settings, as in most modern healthcare settings, should be analysed using a variety of research approaches, beyond efficacy-style randomised controlled trials, to expand and improve practice-based results. (shrink)

Originally published in 1957, this book collects together large sections of important tracts from a variety of political documents, particularly those concerned with democracy, communism, Protestantism or Catholicism. The extracts come from a wide range of authors including Bertrand Russell, Karl Marx, John Locke and Pope Pius XII. This book will be of value to anyone seeking an overview of the key political divisions in the late 20th century or who is interested in political theory generally.

A discussion of the future of interdisciplinary research.

Furthermore, adults with decision-making capacity, including pregnant women, can currently accept interventions with moderate net risks for themselves in other settings (e.g., open f...

In this short paper I will introduce an idea which, I will argue, presents a fundamental additional challenge to the machine consciousness community. The idea takes the questions surrounding phenomenology, qualia and phenomenality one step further into the realm of intersubjectivity but with a twist, and the twist is this: that an agent’s intersubjective experience is deeply felt and necessarily co-affective; it is enkinaesthetic, and only through enkinaesthetic awareness can we establish the affective enfolding which enables first the perturbation, and (...) then the balance and counter-balance, the attunement and co-ordination of whole-body interaction through reciprocal adaptation. (shrink)

Clinical ethics literature typically presents ethics consultations as having clear beginnings and clear ends. Experience in actual clinical ethics practice, however, reflects a different characterization, particularly when the moral experiences of ethics consultants are included in the discussion. In response, this article emphasizes listening and learning about moral experience as core activities associated with clinical ethics consultation. This focus reveals that responsibility in actual clinical ethics practice is generated within the moral scope of an ethics consultant's activities as she or (...) he encounters the unique and specific features that emerge from interactions with a specific patient, or family, or practitioner within a given situation and over time. A long-form narrative about an ethics consultant's interactions is interwoven with a more didactic discussion to highlight the theme of responsibility and to probe questions that arise regarding follow-up within the practice of clinical ethics consultation. (shrink)

We explore psychological contracts as mechanisms by which individuals gain influence in organizations. Using two distinct research settings and longitudinal analysis, we demonstrate that ideological contracts endow individuals with increased centrality in the organization’s influence network. More generally, we propose that an important outcome of different psychological contract types may be how they affect the nature of influence in organizations.

Cognitive agents, whether human or computer, that engage in natural-language discourse and that have beliefs about the beliefs of other cognitive agents must be able to represent objects the way they believe them to be and the way they believe others believe them to be. They must be able to represent other cognitive agents both as objects of beliefs and as agents of beliefs. They must be able to represent their own beliefs, and they must be able to represent beliefs (...) as objects of beliefs. These requirements raise questions about the number of tokens of the belief representation language needed to represent believers and propositions in their normal roles and in their roles as objects of beliefs. In this paper, we explicate the relations among nodes, mental tokens, concepts, actual objects, concepts in the belief spaces of an agent and the agent's model of other agents, concepts of other cognitive agents, and propositions. We extend, deepen, and clarify our theory of intensional knowledge representation for natural-language processing, as presented in previous papers and in light of objections raised by others. The essential claim is that tokens in a knowledge-representation system represent only intensions and not extensions. We are pursuing this investigation by building CASSIE, a computer model of a cognitive agent and, to the extent she works, a cognitive agent herself. CASSIE's mind is implemented in the SNePS knowledge-representation and reasoning system. (shrink)

My aim in this paper is to go some way towards showing that the maintenance of hard and fast dichotomies, like those between mind and body, and the real and the virtual, is untenable, and that technological advance cannot occur with being cognisant of its reciprocal ethical implications. In their place I will present a softer enactivist ontology through which I examine the nature of our engagement with technology in general and with virtual realities in particular. This softer ontology is (...) one to which I will commit Kant, and from which, I will show, certain critical moral and emotional consequences arise. It is my contention that Kant’s logical subject is necessarily embedded in the world and that Kant, himself, would be content with this view as an expression of his inspired response to the ‘‘scandal to philosophy... that the existence of things outside us... must be accepted merely on faith’’ [Bxl]. In keeping with his arguments for the a priori framing of intuition, the a priori structuring of experience through the spontaneous application of the categories, the synthesis of the experiential manifold, and the necessity of a unity of apperception, I will present an enactivist account of agency in the world, and argue that it is our embodied and embedded kinaesthetic engagement in our world which makes possible the syntheses of apprehension, reproduction and recognition, and which, in turn, make possible the activity of the reproductive or creative imagination. (shrink)

Over the past decade, public discussion has focused on the ethics of issuing Do‐Not‐Resuscitate Orders, and the failure of many hospitals to acknowledge their actions openly. Recent efforts on the part of some hospitals to establish formal DNR guidelines that are prudent, fair, and humane, are a helpful beginning, though they cannot account for all the vagaries of illness and human communication. But concerns about DNR should not divert us from looking closely and rigorously at other, more common treatment/nontreatment decisions (...) in the critical care setting. (shrink)

(2001). Activities, Not Rules: The Need for Responsive Practice (On the Way Toward Responsibility) The American Journal of Bioethics: Vol. 1, No. 4, pp. 52-54.

Computational systems biologists create and manipulate computational models of biological systems, but they do not always have straightforward epistemic access to the content and behavioural profile of such models because of their length, coding idiosyncrasies, and formal complexity. This creates difficulties both for modellers in their research groups and for their bioscience collaborators who rely on these models. In this paper we introduce a new kind of visualization that was developed to address just this sort of epistemic opacity. The visualization (...) is unusual in that it depicts the dynamics and structure of a computer model instead of that model’s target system, and because it is generated algorithmically. Using considerations from epistemology and aesthetics, we explore how this new kind of visualization increases scientific understanding of the content and function of computer models in systems biology to reduce epistemic opacity. (shrink)

The current study examined whether Callous-Unemotional (CU) traits, a core component of psychopathy, modulate neural responses of participants engaged in a social exchange game. In this task, participants were offered an allocation of money and then given the chance to punish the offerer. Twenty youth participated and responses to both offers and the participant’s punishment (or not) of these offers were examined. Increasingly unfair offers were associated with increased dorsal anterior cingulate cortex (dACC) activity but this responsiveness was not modulated (...) by CU traits. Increasing punishment of unfair offers was associated with increased dACC and anterior insula activity and this activity was modulated by CU traits. Higher CU trait participants showed a weaker association between activity and punishment level. These data suggest that CU traits are associated with appropriate expectations of other individual’s normative behavior but weaker representations of such information when guiding behavior of the self. (shrink)

Working within the tradition of continental philosophy, this article argues in favour of a phenomenological understanding of language as a crucial component of bioethical inquiry. The authors challenge the ‘commonsense’ view of language, in which thinking appears as prior to speaking, and speech the straightforward vehicle of pre-existing thoughts. Drawing on Maurice Merleau-Ponty's (1908–1961) phenomenology of language, the authors claim that thinking takes place in and through the spoken word, in and through embodied language. This view resituates bioethics as a (...) matter of bodies that speak. It also refigures the meaning of ethical self-reflexion, and in so doing offers an alternative view on reflexivity and critique. Referring to the Kantian critical tradition and its reception by Hannah Arendt and Michel Foucault, we advance a position we call ‘critical ethical reflexivity’. We contend that Merleau-Ponty's phenomenology of language offers valuable insight into ethical reflexivity and subject formation. Moreover, his understanding of language may foster new qualitative empirical research in bioethics, lead to more nuanced methods for interpreting personal narratives, and promote critical self-reflexion as necessary for bioethical inquiry. (shrink)

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of (...) literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

The primary aim of this essay is to present a case for a heavily revised notion of heterophenomenology. l will refer to the revised notion as ‘enkinaesthesia’ because of its dependence on the experiential entanglement of our own and the other’s felt action as the sensory background within which all other experience is possible. Enkinaesthesia2 emphasizes two things: (i) the neuromuscular dynamics of the agent, including the givenness and ownership of its experience, and (ii) the entwined, blended and situated co-affective (...) feeling of the presence of the other(s), agential (for example, human, horse, cat, beetle) and non-agential (for example, cup, bed, apple, paper) and, where appropriate, the anticipated arc of the other’s action or movement, including, again where appropriate, the other’s intentionality. When the ‘other’ is also a sensing and experiencing agent it is their - in this case, the pair’s - affective intentional reciprocity, their folding, enfolding, and unfolding, which co-constitutes the conscious relation and the experientially recursive temporal dynamics that lead to the formation and maintenance of the deep integral enkinaesthetic structures and melodies which bind us together, even when they pull us apart. Such deeply felt enkinaesthetic melodies emphasise the dialogical nature of the backgrounded feeling of being. (shrink)

BackgroundCentral to ethically justified clinical trial design is the need for an informed consent process responsive to how potential subjects actually comprehend study participation, especially study goals, risks, and potential benefits. This will be particularly challenging when studying deep brain stimulation and whether it impedes symptom progression in Parkinson’s disease, since potential subjects will be Parkinson’s patients for whom deep brain stimulation will likely have therapeutic value in the future as their disease progresses.MethodAs part of an expanded informed consent process (...) for a pilot Phase I study of deep brain stimulation in early stage Parkinson’s disease, an ethics questionnaire composed of 13 open-ended questions was distributed to potential subjects. The questionnaire was designed to guide potential subjects in thinking about their potential participation.ResultsWhile the purpose of the study (safety and tolerability) was extensively presented during the informed consent process, in returned responses 70 percent focused on effectiveness and 91 percent included personal benefit as potential benefit from enrolling. However, 91 percent also indicated helping other Parkinson’s patients as motivation when considering whether or not to enroll.ConclusionsThis combination of responses highlights two issues to which investigators need to pay close attention in future trial designs: (1) how, and in what ways, informed consent processes reinforce potential subjects’ preconceived understandings of benefit, and (2) that potential subjects see themselves as part of a community of Parkinson’s sufferers with responsibilities extending beyond self-interest. More importantly, it invites speculation that a different paradigm for informed consent may be needed. (shrink)

Machine consciousness exists already in organic systems and it is only a matter of time -- and some agreement -- before it will be realised in reverse-engineered organic systems and forward- engineered inorganic systems. The agreement must be over the preconditions that must first be met if the enterprise is to be successful, and it is these preconditions, for instance, being a socially-embedded, structurally-coupled and dynamic, goal-directed entity that organises its perceptual input and enacts its world through the application of (...) both a cognitive and kinaesthetic imagination, that I shall concentrate on presenting in this paper. It will become clear that these preconditions will present engineers with a tall order, but not, I will argue, an impossible one. After all, we might agree with Freeman and Núñez's claim that the machine metaphor has restricted the expectations of the cognitive sciences (Freeman & Núñez, 1999); but it is a double-edged sword, since our limited expectations about machines also narrow the potential of our cognitive science. (shrink)

We propose Rhythmic Relating for autism: a system of supports for friends, therapists, parents, and educators; a system which aims to augment bidirectional communication and complement existing therapeutic approaches. We begin by summarizing the developmental significance of social timing and the social-motor-synchrony challenges observed in early autism. Meta-analyses conclude the early primacy of such challenges, yet cite the lack of focused therapies. We identify core relational parameters in support of social-motor-synchrony and systematize these using the communicative musicality constructs: pulse; quality; (...) and narrative. Rhythmic Relating aims to augment the clarity, contiguity, and pulse-beat of spontaneous behavior by recruiting rhythmic supports and relatable vitality; facilitating the predictive flow and just-ahead-in-time planning needed for good-enough social timing. From here, we describe possibilities for playful therapeutic interaction, small-step co-regulation, and layered sensorimotor integration. Lastly, we include several clinical case examples demonstrating the use of Rhythmic Relating within four different therapeutic approaches. These clinical case examples are introduced here and several more are included in the Supplementary Material. A suite of pilot intervention studies is proposed to assess the efficacy of combining Rhythmic Relating with different therapeutic approaches in playful work with individuals with autism. Further experimental hypotheses are outlined, designed to clarify the significance of certain key features of the Rhythmic Relating approach. (shrink)

Open peer commentary on the article “Enacting the “Body” of Neurophenomenology: Off-Radar First-Person Methodologies in Pragmatics of Experiencing” by Jakub Petri & Artur Gromadzki. Abstract: Petri and Gromadzki have produced a thought-provoking article that, rather unfortunately, places itself wide of the mark in a couple of places. I will lay out and address their two major concerns and conclude with some remarks about their proposal for broadening the field of neurophenomenological enquiry.

In lieu of an abstract, here is a brief excerpt of the content:IntroductionStuart J. Youngner (bio), Laura A. Siminoff (bio), and Renie Schapiro (bio)This issue of the Kennedy Institute of Ethics Journal (KIEJ) centers on a piece of empirical research. The motivation behind the study of Laura Siminoff, Christopher Burant, and Stuart Youngner (2004) was to find out more about what the general public understands and believes about when a person is dead. More specifically, the study tried to determine (...) how members of the public define death, especially their acceptance and interpretation of the medical concept of "brain death," and their attitudes toward the so-called "dead donor rule," an informal but powerful social and legal norm insisting that the taking of organs for transplantation not cause the death of the source of those organs.As the demand for organs increases and the waiting list grows, the United States has explored multiple ways to expand the pool of potential donors. One approach has been to gerrymander (coherently or not) the line between life and death to shift patients who are extremely compromised but traditionally considered to be in the living category into the dead category. In this way, the dead donor rule remains technically intact. This reasoning is explicit in the report of the Harvard Medical School Ad Hoc Committee (1968) that "introduced" "brain death" to the American culture. Since then, other efforts to redraw the line have been proposed and rejected.One alternative to gerrymandering is to consider under what conditions, if any, it is morally acceptable to violate the dead donor rule. Some would argue that this alternative is the more "honest" approach. Rather than sidestepping moral problems by calling people dead, it brings the moral problems to the surface where the necessity of sticking to the rule can be considered on its own merits. However, when the Journal of the American Medical Association printed a position paper that proposed making anencepahlic newborns an exception to the dead donor rule, along with arguments about why this was acceptable, the outcry was so great that the proposal was retracted (AMA 1995).Clearly, our society has identified organ transplantation as a priority, although two papers in this volume (those by Courtney Campbell and by Megan Crowley-Matoka and Robert Arnold) take issue with that prioritization. The fact that the donor pool has remained relatively stable (and inadequate) despite massive efforts [End Page 211] to increase it speaks, at least in part, to the cultural and legal resistance to "new" ways to procure more organs. Voluntarism seems to have peaked. Financial incentives clash with the heavily endorsed notion of the "gift of life" and seem to many to violate the dignity of the human body. Presumed consent or eminent domain, in which the community has a greater claim to a person's organs than that person or his/her family, go against the grain of American individual freedom and the ethos of patient autonomy.Abandoning the dead donor rule generally is regarded as an even tougher sell to the American public and its legislators. The study by Siminoff and colleagues attempts, among other things, to gauge just how tough this sell would be. What the data actually demonstrate is a matter of interpretation, and this issue of the KIEJ is devoted to some of those interpretations. The authors, with the exception of Daniel Hausman, came together for a meeting in Cleveland, Ohio, during which the study's methods and data were presented with time for questions, clarifications, and general discussion. The authors then worked with the editors to generate the papers printed in this volume.The issue begins with a presentation of the study conducted by Siminoff and colleagues. The same paper also appears in the journal Social Science and Medicine, where it includes the conclusions of the authors (Siminoff, Burant, and Youngner 2004). In the current volume, we present only the methodology of and data from the study, allowing a number of distinguished commentators to offer their own conclusions and reflections.The first response comes from Tracy Schmidt, Executive Director of Intermountain Donor Services, one of our nation's organ procurement organizations (OPOs). For years, organ procurement professionals have reported anecdotal stories about families who wished to donate organs of... (shrink)

We revisit questions about the scientific status of the pilot Phase I study of deep brain stimulation (DBS) in early stage Parkinson’s disease (PD), as well as questions about enrolling and retaining subjects. In doing so, we highlight a compelling ethical dimension reported to us by patients thinking about becoming research subjects in that study.

Open peer commentary on the article “The Uroboros of Consciousness: Between the Naturalisation of Phenomenology and the Phenomenologisation of Nature” by Sebastjan Vörös. Upshot: Vörös proposes that we phenomenologise nature and, whilst I agree with the spirit and direction of his proposal, the 4EA framework, on which he bases his project, is too conservative and is, therefore, unsatisfactory. I present an alternative framework, an enkinaesthetic field, and suggest further ways in which we might explore a non-dichotomised “betwixt” and begin to (...) experience our world in a non-individuating, non-dual aspect. (shrink)

What might become of anthropology if it were to suspend its sometime claims to be a social science? What if it were to turn instead to exploring its affinities with art and literature as a mode of engaged creative practice carried forward in a world heterogeneously composed of humans and other than humans? Stuart McLean claims that anthropology stands to learn most from art and literature not as "evidence" to support explanations based on an appeal to social context or (...) history but as modes of engagement with the materiality of expressive media--including language--that always retain the capacity to disrupt or exceed the human projects enacted through them. At once comparative in scope and ethnographically informed, Fictionalizing Anthropology draws on an eclectic range of sources, including ancient Mesopotamian myth, Norse saga literature, Hesiod, Lucretius, Joyce, Artaud, and Lispector, as well as film, multimedia, and performance art, along with the concept of "fabulation" (the making of fictions capable of intervening in and transforming reality) developed in the writings of Bergson and Deleuze. Sharing with proponents of anthropology's recent "ontological turn," McLean insists that experiments with language and form are a performative means of exploring alternative possibilities of collective existence, new ways of being human and other than human, and that such experiments must therefore be indispensable to anthropology's engagement with the contemporary world. (shrink)

The A to Z of Leibniz's Philosophy sheds light not only on his philosophical thought but also the impact it had on the thinking of his contemporaries. They, and he, are described in numerous cross-referenced dictionary entries. Also included are other entries that present his writings, explain his concepts, and trace his action in specific fields. The introduction sums much of this up and—along with the bibliography—provides a strong foundation for further study.

This Open Access book about the Zadeh Project demonstrates and explores a core question in clinical ethics: how can ethics consultants be accountable in the face of a robust plurality of ethical standpoints, especially those that underwrite practices and methods for doing ethics consultation as well as those viewpoints and values encountered in daily clinical ethics practice? Underscoring this question is the recognition that the field of clinical ethics consultation has arrived at a crucial point in its maturation. Many efforts (...) are underway to more formally “professionalize” the field, with most aimed toward stabilizing a specific set of institutional considerations. Stretched between these institutional and practical initiatives resides a crucial set of of ethical considerations, chief among them the meaning and scope of responsibility for clinical ethics consultants. Developed around a long-form case scenario, the Zadeh Project provides a multi-layered series of “peer-reviews”: critique of the actions of the case scenario’s ethics consultant; reflection on clinical ethics method; examination of the many ways that commitments to method and practice can, and do, intersect, overlap, and alter one another. The design and format of this book thus models a key element for clinical ethics practice: the need and ability to provide careful and thoughtful explanation of core moral considerations that emerge among diverse standpoints. Specifically designed for those studying to become and those who are ethics consultants, this book, with its innovative and multi-layered approach, allows readers to share a peer-review-like experience that shows accountability to be what it is, an ethical, not merely procedural or administrative, undertaking. (shrink)

In a number of surveys, Canadian farmers have found the absence of information to be a major obstacle to the development of sustainable agriculture. The traditional sources of information for farmers have been unable to provide them with suitable information. One reason for this deficiency is the absence of suitable training for agriculture professionals. The details of a newly created course designed to address these problems at the Faculty of Agriculture of McGill University are provided, and some suggestions made about (...) the pedagogy and course content of an entire program. (shrink)