Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

In this article, we discuss a hypothesis to explain the preferential synthesis of the superoxide sensitive form of aconitase in mitochondria and the phenotype observed in manganese superoxide dismutase mutant mice, which show a gross over accumulation of stored fat in liver. The model proposes that intermediary metabolism is redox regulated by mitochondrial superoxide generated during mitochondrial respiration. This regulates the level of reducing equivalents (NADH) entering the electron transport chain (ETC) through the reversible inactivation of mitochondrial aconitase. This control (...) mechanism has a dual function; firstly, it regulates levels of superoxide generated by the ETC and, secondly, it fine‐tunes metabolism by channeling citrate either for the production of NADH for energy metabolism or diverting it for the synthesis of fats. In this setting, the mitochondrial redox state influences metabolic decisions via a superoxide–aconitase rheostat. BioEssays 26:894–900, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

It has been proposed that inferring personal authorship for an event gives rise to intentional binding, a perceptual illusion in which one’s action and inferred effect seem closer in time than they otherwise would . Using a novel, naturalistic paradigm, we conducted two experiments to test this hypothesis and examine the relationship between binding and self-reported authorship. In both experiments, an important authorship indicator – consistency between one’s action and a subsequent event – was manipulated, and its effects on binding (...) and self-reported authorship were measured. Results showed that action-event consistency enhanced both binding and self-reported authorship, supporting the hypothesis that binding arises from an inference of authorship. At the same time, evidence for a dissociation emerged, with consistency having a more robust effect on self-reports than on binding. Taken together, these results suggest that binding and self-reports reveal different aspects of the sense of authorship. (shrink)

Of Goals and Goods and Floundering About: A Dissensus Report on Clinical Ethics Consultation Content Type Journal Article Pages 275-291 DOI 10.1007/s10730-009-9101-1 Authors Jeffrey P. Bishop, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Joseph B. Fanning, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Mark J. Bliton, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, (...) Suite 400 Nashville Tennessee 37203 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 3. (shrink)

Technology is evolving at a rate faster than human evolution, especially human moral evolution. There are those who claim that we must morally bioenhance the human due to existential threats (such as climate change and the looming possibility of cognitive enhancement) and due to the fact that the human animal has a weak moral will. To address these existential threats, we must design human morality into human beings technologically. By moral bioenhancement, these authors mean that we must intervene technologically in (...) the biology of the human animal in order to get it to behave morally to address these existential threats. I will bring the idea of moral bioenhancement into conversation with two philosophers of technology. Bernard Stiegler has argued that technology and culture, and thus technology and human beings, have always evolved hand in hand. Peter-Paul Verbeek notes that we have always designed morality into technology, and thus he sees technology as mediating human morality. When we offload human intentionality onto technology, Verbeek argues, technological objects and systems participate in shaping the moral subjectivity of the human actor. I will show that modern technological bioenhancement obliterates human being. Whereas in the past, human culture was handed from generation to generation through the mediation of technology, in the modern era, the human becomes the raw material upon which a technological will (imperative) rides. (shrink)

The influence of neuroscience looms large today. In this introductory essay, we provide some context for the volume by acknowledging the expansion of applied neuroscience to everyday life and the proliferation of neuroscientific disciplines. We also observe that some individuals have sounded cautionary notes in light of perceived overreach of some claims for neuroscience. Then we briefly summarize the articles that comprise this volume. This diverse collection of papers represents the beginning of a conversation focused on the intersection of sport, (...) ethics and neurophilosophy. As such, the essays also represent a new mode of interaction between philosophy and science with sport in the center of the discussion. (shrink)

McKay & Dennett (M&D) convincingly argue against many proposals for adaptively functioning misbelief, but the conclusion that true beliefs are generally adaptive does not follow. Adaptive misbeliefs may be few in kind but many in number; maladaptive misbeliefs may routinely elude selective pruning; reproductively neutral misbeliefs may abound; and adaptively grounded beliefs may reliably covary with but not truthfully represent reality.

Belief in free will is widespread. The present research considered one reason why people may believe that actions are freely chosen rather than determined: they attribute randomness in behavior to free will. Experiment 1 found that participants who were prompted to perform a random sequence of actions experienced their behavior as more freely chosen than those who were prompted to perform a deterministic sequence. Likewise, Experiment 2 found that, all else equal, the behavior of animated agents was perceived to be (...) more freely chosen if it consisted of a random sequence of actions than if it consisted of a deterministic sequence; this was true even when the degree of randomness in agents’ behavior was largely a product of their environments. Together, these findings suggest that randomness in behavior—one’s own or another’s—can be mistaken for free will. (shrink)

A reader confronting this collection of essays might wonder if something went awry in Jacksonville, Florida, in February 2014, when conference organizers gathered pediatric bioethicists and international child rights advocates to discuss the application of the U.N. Convention on the Rights of the Child to the work of clinical bioethics in the United States. Surely a document proclaiming a worldwide consensus on child rights would strengthen the hand of ethicists advising clinicians and researchers who face difficult decisions. Yet the conference (...) discussion—and resulting manuscripts—depict a deep divide: bioethicists largely rejected the notion that the CRC is a useful.. (shrink)

This chapter contains sections titled: Introduction Investing in Science: Child Health and U.S. Medicine in the Twentieth Century The Impact of Specific Medical Interventions The Changing Definition of ID The “Flynn Effect” and the Impact of Improved Public Health Conclusion References.

This paper explores three phenomena in sport that are connected to narratives of hope: underdogs, upsets, and overachievers. Each of these phenomena is complex. I seek not only to understand the intrinsic nature of these phenomena, but also to explain why they captivate the imagination. After exploring some partial explanations of their enduring appeal, I focus on how the drama associated with underdogs, upsets, and overachievers in sport illuminates the human condition and awakens our sense of possibility when the odds (...) are against us. (shrink)

Volume 47, Issue 2, July 2020, Page 322-325.

The Heythrop Journal, Volume 63, Issue 3, Page 333-348, May 2022.

Despite a century of progress in medical knowledge, many diagnostic odysseys end in disappointment, especially when the child has a developmental disorder. In cases of autism and intellectual disability, relatively few children receive a specific diagnosis, and virtually none of those diagnoses lead to a specific medical treatment. Whole‐genome or ‐exome sequencing offers a quantum leap in the diagnostic odyssey, in that we will always learn something from sequencing—sometimes much more than families bargained for, as discussed elsewhere in this special (...) report. The trick is whether the knowledge gained will help the child and family. A family‐centered approach gives families permission to choose but does not lay all of the responsibility on them. The goal is to pursue the degree of medical diagnostic evaluation that matches the family's values. (shrink)

The call for a narrative medicine has been touted as the cure-all for an increasingly mechanical medicine. It has been claimed that the humanities might create more empathic, reflective, professional and trustworthy doctors. In other words, we can once again humanise medicine through the addition of humanities. In this essay, I explore how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing, perpetuates a dualism of (...) humanity that would have humanism as the counterpoint to the biopsychosociologisms of our day. (shrink)

The COVID-19 pandemic has had an impact on every aspect of our social, cultural and commercial lives, including the world of sport. This book examines the ethical and philosophical dimensions of the intersection of COVID-19 and sport. The book goes beyond simple description of the impact of the pandemic on sport to offer normative judgments about how the sporting world responded to challenges posed by COVID-19, as well as philosophical speculation as to how COVID-19 will change our understanding and appreciation (...) of sport in the long term. It examines the considerations that either influenced - or arguably should have influenced - decisions to continue or to resume the playing of organized sport in the midst of a pandemic. As a part of this analysis, a spotlight is shone on how sport intersected with political issues surrounding COVID-19. It also explores the configuration and meaning of sport in the COVID-19 era, touching on themes such as the nature of sport, and its integrity, and sport's relationship to technology. Other themes include the changed nature of spectatorship, suffering in sport during pandemic times, and the impact of COVID-19 on the Olympic and Paralympic Games. A final chapter looks ahead and asks what sport might look like in a post-COVID world. This is fascinating reading for anybody with an interest in the ethics and philosophy of sport, the sociology of sport, event studies, politics or public health. (shrink)

The first ethics casebook that integrates clinical ethics (medical, nursing, and dental) and research ethics with public health and informatics. The book opens with five chapters on ethics, the development of interprofessional ethics, and brief instructional materials for students on how to analyze ethical cases and for teachers on how to teach ethics. In today's rapidly evolving healthcare system, the cases in this book are far more realistic than previous efforts that isolate the decision-making process by professions as if each (...) is not embedded in a larger context that involves healthcare teams, hospital policies, and technology. The central claim of this book is that ethics is an important common ground for all of the health professions. Furthermore, when we recognize that our professions converge upon a common goal we will find less conflict and more pleasure in working together. (shrink)

Guiding our response in this essay is our view that current efforts to demarcate the role of the clinical ethicist risk reducing its complex network of authorizations to sites of power and payment. In turn, the role becomes susceptible to various ideologies—individualisms, proceduralisms, secularisms—that further divide the body from the web of significances that matter to that body, where only she, the patient, is located. The security of policy, standards, and employment will pull against and eventually sever the authorization secured (...) by authentic moral inquiry. Instead of asking “What do I need to know?”, the question animating the drive to standardize will be “What is the policy or standard?” The claims of the authors in this issue of HEC Forum confirm these suspicions. (shrink)

In this paper I explore the nature, varieties, causes and meanings of comebacks related to sport. I argue that comebacks have an axiological dimension, and that the best comebacks involve personal growth. I attempt to show that a major reason that comebacks connected to sport are often inspiring is that we are all in need of a comeback at some point in our lives. When improbable comebacks occur in the world of sport, they expand our sense of possibility.

Informed consent is the single most important concept for understanding decision-making capacity. There is a steady pull in the clinical world to transform capacity into a technical concept that can be tested objectively, usually by calling for a psychiatric consult. This is a classic example of medicalization. In this article I argue that is a mistake, not just unnecessary but wrong, and explain how to normalize capacity assessment.Returning the locus of capacity assessment to the attending, the primary care doctor, and (...) even to ethics consultation in today's environment will require a substantial effort to undo a strong but illusory impression of capacity assessment. Hospital attorneys as well as clinical ethicists with a sophisticated understanding of health law can be in the vanguard of this reorientation. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 13-15, August 2012.

Technology tends toward perpetual innovation. Technology, enabled by both political and economic structures, propels society forward in a kind of technological evolution. The moment a novel piece of technology is in place, immediately innovations are attempted in a process of unending betterment. Bernard Stiegler suggests that, contra Heidegger, it is not being-toward-death that shapes human perception of time, life, death, and meaning. Rather, it is technological innovation that shapes human perception of time, life, death, and meaning. In fact, for Stiegler, (...) human evolution has always been part of technological evolution. While one can quibble with the notion of human-technology co-evolution, there is something to be said for the way in which human perception of time, of ageing, and of death seems to be judged against the horizon of perpetual evolution of technological innovation. In this technological imaginary, of which modern medicine is constituent, ageing and death seemingly may be infinitely deferred, and it is this innovating deferral that shapes the contemporary social imaginary around ageing and death in modern medicine. Yet, the reality of living (which is to say ageing) and dying always manifests itself differently than the scripts given to us by the technological imaginary with its myth of endless innovation. In fact, I shall argue that, where the Church created an ars moriendi, the technological imaginary gives us an ars ad mortem when it becomes clear that ageing and death cannot be infinitely deferred. And further, I shall argue that the Church must revivify its ars vivendi—that is to say, its liturgies, its arts, its technics—as a counter narrative to the myth of perpetual innovation that shapes the technological imaginary. (shrink)

: The supply of organs for transplant remains inadequate to meet the needs of waiting patients, in spite of many programs and approaches to increase rates of donation. Over the years there have been numerous proposals to introduce schemes that would move toward the outright sale of organs. Three articles in this issue of the Journal propose methods for increasing organ supply—two by moving toward a market approach and the third by advocating a change in social culture. All three suffer (...) from shortcomings, including the endorsement and encouragement of the exploitation of those who may offer organs. Although the shortage of organs must be addressed, the social price of a market in organs is too high, and proposals to encourage a rethinking of social responsibility are unlikely to be effective. (shrink)

Transhumanism traces its roots to Enlightenment humanism and claims to be the harbinger of the next phase of humanistic activity through designer evolution. In this essay, I briefly trace medicine’s relationship with transhumanist philosophy to the philosophy of medicine and show that each accepts a kind of ambiguity of the body at the heart of its metaphysical assumptions. I show that these metaphysical assumptions are committed to a power ontology, and that this power ontology is fundamentally at odds with the (...) traditional Christian lifeworld. (shrink)

Abstract:Epode 16, Horace's famous decline poem about Rome before Actium, has long been viewed as a cynical response to Vergil's prophecy of a returning Golden Age in Eclogue 4. In this article, I argue that there is another, unrecognized intertext for Epode 16—Pindar's Olympian 2—to which Horace's bleak poem alludes in a "window reference" refracted through Vergil's bucolic. As such, Horace's cynicism represents, in fact, a lament over the lost simplicity and timelessness of Greek oral poetry, and an attempt to (...) reclaim for his listeners/readers the originary experience of listening. In so doing, Horace takes up the Pindaric mantle of poet-prophet. (shrink)

This comment focuses on the informational distinction Brian Skyrms makes between rational choice theories of the social contract and theories based on evolutionary dynamics. The basic point is that to dismiss the rational choice method because of the restrictive informational assumptions may discount interesting work done in the area of bounded rationality. Further, the comment argues that combining the best elements of both approaches into an evolutionary theory of boundedly rational agents can improve the power of social contract theories. To (...) illustrate the point, we work through an example of analysing the data from a bargaining experiment. (shrink)

Since surrogates are not good at predicting patient preferences, and since these decisions can cause surrogates distress, some have claimed we need an alternative way to make decisions for incapaci...

A fourteen year old is diagnosed with aplastic anemia. The teen and his parents are Jehovah’s Witnesses. An ethics consult is called on the day of admission by an ethically sophisticated social worker and attending. The patient and his parents see this diagnosis as “a test of their faith.” The ethical analysis focuses on the mature minor doctrine, i.e. whether the teen has the capacity to make this decision. The hospital chooses to take the case to court, with a result (...) that is at odds with the ethics consultation recommendations. Ethics was never deposed or otherwise invited to be involved with the hearing. Thus the larger question of the relation of ethics and law was brought into stark relief. (shrink)

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care (...) managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)