The question of whether clinical ethics consultants may engage in patient advocacy in the course of consultation has not been addressed, but it highlights for the field that consultants? allegiances, and the boundaries of appropriate professional practice, must be better understood. I consider arguments for and against patient advocacy in clinical ethics consultation, which demonstrate that patient advocacy is permissible, but not central to the practice of consultation. I then offer four recommendations for consultants who engage in patient advocacy, and (...) consider the implications of this issue for the field.1. (shrink)

This paper presents an analysis of emotional and affectively toned discourse in biomedical engineering researchers’ accounts of their problem solving practices. Drawing from our interviews with scientists in two laboratories, we examine three classes of expression: explicit, figurative and metaphorical, and attributions of emotion to objects and artifacts important to laboratory practice. We consider the overall function of expressions in the particular problem solving contexts described. We argue that affective processes are engaged in problem solving, not as simply tacked onto (...) reasoning but as integral to it. The examples we present illustrate the close relation of emotion to problem solving and experimentation; they also implicate social and cultural dimensions of emotion expression. The analysis underscores a need to consider emotional expression to be intimately and importantly tied to the cognitive achievements and social negotiations of laboratory practices. (shrink)

The attempt to critique the profession of clinical ethics consultation by establishing the impossibility of ethics expertise has been a red herring. Decisions made in clinical ethics cases are almost never based purely on moral judgments. Instead, they are all-things-considered judgments that involve determining how to balance other values as well. A standard of justified decision-making in this context would enable us to identify experts who could achieve these standards more often than others, and thus provide a basis for expertise (...) in clinical ethics consultation. This expertise relies in part on what Richard Zaner calls the “expert knowledge of ethical phenomena”. (shrink)

Volume 19, Issue 9, September 2019, Page 44-45.

Confronting any science studies or learning sciences researcher in the 21st century is the reality of interdisciplinary science. New hybrid fields1 collaboratively build new concepts, combine models from two or more disciplines and forge inter-reliant relationships among specialists with different skill sets to solve new problems. This paper emerges from our recognition that inescapable psychological factors, including identity dynamics, must be described and analyzed in order to better understand the social and cognitive practices specific to interdisciplinary science. In analysis of (...) the foundations and opportunities for an... (shrink)

Contemporary biomedical ethics and environmental ethics share a common ancestry in Aldo Leopold's and Van Rensselaer Potter's initial broad visions of a connected biosphere. Over the past five decades, the two fields have become strangers. Public health ethics, a new subfield of bioethics, emerged from the belly of contemporary biomedical ethics and has evolved over the past 25 years. It has moved from its traditional concern with the tension between individual autonomy and community health to a wider focus on social (...) justice and solidarity. Public health has a broad focus that includes individual, community, and environmental health. Public health ethics attends to these broad commitments reflected in the increasing concern with the connectedness of health of individuals to the health of populations, to the health of animals, to the health of the environment; it is well situated to reconnect all three “fields” of ethics to promote a healthier planet. (shrink)

Validation of a biomarker-based medical product development tool or clinical test is an evidentiary process that must be tailored to the proposed use. Appropriate data and analyses are needed to demonstrate that the biomarker meets analytical and clinical performance criteria consistent with favorable benefit: risk balance.

Ethical considerations from both the clinical and public health perspectives have been used to examine whether it is ethically permissible to mandate the seasonal influenza vaccine for healthcare workers (HCWs). Both frameworks have resulted in arguments for and against the requirement. Neither perspective resolves the question fully. By adding components of justice to the argument, I seek to provide a more fulsome ethical defence for requiring seasonal influenza immunisation for HCWs. Two critical components of a just society support requiring vaccination: (...) fairness of opportunity and the obligation to follow democratically formulated rules. The fairness of opportunity is informed by Rawls’ two principles of justice. The obligation to follow democratically formulated rules allows us to focus simultaneously on freedom, plurality and solidarity. Justice requires equitable participation in and benefit from cooperative schemes to gain or profit socially as individuals and as a community. And to be just, HCW immunisation exemptions should be limited to medical contraindications only. In addition to the HCWs fiduciary duty to do what is best for the patient and the public health duty to protect the community with effective and minimally intrusive interventions, HCWs are members of a just society in which all members have an obligation to participate equitably in order to partake in the benefits of membership. (shrink)

In their article “The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments,” Ray and Cooper (2024) invite us to prioritize environmental health...

Despite increased interest in “intuition” within cognitive psychology, the conceptual framework of this notion remains problematic. This paper argues that conceptual shortcomings stem from a tendency to ignore the philosophical heritage of intuition or to dismiss the relevance of this heritage to contemporary theory. The paper outlines major understandings of intuition within psychology and prominent philosophical traditions, highlighting important points of inconsistency in these and examining consequences of the inconsistency. It also considers psychological conceptions of intuition that more readily overlap (...) with philosophical accounts and offers some suggestions toward a more philosophically informed notion of intuition relevant to contemporary psychological theory. (shrink)

The cognitive revolution in the 1950s and 1960s led researchers to view the human mind--like a computer--as an information-processing system that encodes, represents, and stores information and is constrained by limits on hardware and software. The emergence of new behavioral, computational, and neuroscience methodologies, has deeply expanded psychologists' understanding of the workings of the infant, child, and adult mind. One result is that research has focused on mechanisms of change, over developmental time, in the information-processing mind.In this book, Lisa (...) Oakes, Cara Cashon, Marianella Casasola, and David Rakison bring together the recent findings and theories about the origins and early development of the information-processing mind, and provide insight into the future directions in the study of infant perception and cognition. The contributors represent a wide-range of research areas in the study of infant perception and cognition, who emphasize the use of diverse methodological techniques to address key questions about development. Their chapters demonstrate how the combination of historical perspectives on the information-processing approach to cognition and recent advances in behavioral, computational, and neuroscience approaches to cognition has contributed to our understanding of how abilities ranging from visual attention to face processing to object categorization have developed during infancy. Across this broad range of topics, it is clear that much of our modern understanding of infant perceptual and cognitive development emerges from the foundation of classic information-processing models of development, such as that of Leslie B. Cohen. The recent advances illustrated in this book show how researchers have built on this foundation to uncover the mechanisms that drive developmental change. (shrink)

Alan Westin’s work Privacy and Freedom remains foundational to the field of privacy, and Westin is frequently cited for his definition of privacy as control over personal information. However, Westin’s full definition of privacy is much more complex than this statement, describing four states of privacy (solitude, intimacy, anonymity, and reserve) that one achieves through physical or psychological means. The “claim” of privacy involves negotiating a balance between a desire for disclosure and social participation and a desire for withdrawal into (...) one of the “states” of privacy. Influencing this adjustment process are social norms (and surveillance to enforce social norms), environmental conditions, and the curiosity of others. In this Article, I draw upon this complexity in order to reread Westin’s definition of privacy as a claim of control over personal information and use this rereading to understand how the law should protect and promote privacy in the twenty-first century. I argue that the law should focus on securing meaningful privacy choices rather than on individual control over personal information. Meaningful choice requires that our informational infrastructure, and the social practices that it enables, make states of privacy available for choice along with the means of attaining them. To enable such meaningful individual choice, we need to shift our attention from a focus on individuals to a more systemic focus on our public norms and built infrastructure. Otherwise we risk protecting a narrow understanding of individual control, while ignoring a more general and systematic erosion of privacy. (shrink)

Volume 20, Issue 10, October 2020, Page 61-63.

What about Confucian bioethics should compel our interest? Apart from the fact that Confucianism grounds the belief system of a great number of people, a Confucian bioethics poses a profound challe...

The ethical (and philosophical) issues arising in citizen science are fascinating, challenging, and potentially pathbreaking in that they force us to reconsider the conceptual and regulatory catego...

The first Ethics Bowl competition was established in the 1990s by Dr. Robert Ladenson of the Illinois Institute of Technology to help students reason through ethical challenges they will face in their personal and professional lives, and help them develop responsibilities as citizens of a democracy. Since then, the Ethics Bowl format and its pedagogical goals have been adapted to many other academic disciplines and a variety of student and professional populations. Our aim was to quantify the growth of the (...) Ethics Bowl concept by enumerating and describing extant Ethics Bowl programs, outlining both pedagogical goals and operational aspects. Using respondent-driven sampling, we identified 20 Ethics Bowl programs across the globe, reaching tens of thousands of participants annually, and an additional two programs preparing to launch in the near future. We conclude by making recommendations for pedagogical and operational dimensions of the programs. (shrink)

Patients and surgeons participate in shared decision making when they make healthcare decisions together, taking into account the patient’s goals, values, and preferences. Surgical treatment is pursued when the potential benefits outweigh the risks, the burdens of treatment are acceptable, and no other alternatives are more appropriate for meeting the patient’s goals of care. Acute care surgical problems require shared decision making, often with constraining factors that include the time-sensitive and life-threatening nature of acute surgical disease, absence of a patient’s (...) decision-making capacity, and lack of a preexisting relationship between the patient and surgeon. These factors may create ethical challenges for acute care surgeons who care for these patients. (shrink)

A subcommittee of the American Association of University Professors has published a report, “Research on Human Subjects: Academic Freedom and the Institutional Review Board” , which argues that institutional review board oversight may pose a threat to academic freedom, and that a different oversight model based on departmental review would both maintain subject protection and eliminate the threat. But the report does not demonstrate that IRBs pose a threat to academic freedom, and using departmental oversight may not sufficiently protect human (...) subjects of research, could introduce other problems, and would itself pose threats to academic freedom. Instead, some alternative methods of streamlining IRB oversight for certain types of research would better address the practical problems currently encountered. (shrink)

The development of physical theory is one of our greatest intellectual achievements. Its products--the currently prevailing theories of physics, astronomy, and cosmology--have proved themselves to possess intrinsic beauty and to have enormous explanatory and predictive power. This anthology of primary readings chronicles the birth and maturation of five such theories (the heliocentric theory, the electromagnetic field theory, special and general relativity, quantum theory, and the big bang theory) in the words of the scientists who brought them to life. It is (...) the first historical account that captures the rich substance of these theories, each of which represents a fascinating story of the interplay of evidence and insight--and of dialogue among great minds. Readers sit in with Copernicus, Kepler, and Galileo as they overturn the geocentric universe; observe the genius of Faraday and Maxwell as they "discover" the electromagnetic field; look over Einstein's shoulder as he works out the details of relativity; listen in as Einstein and Bohr argue for the soul of quantum mechanics in the Completeness Debate; and watch as Hubble and others reveal the history of the universe. The editors' approach highlights the moments of discovery that rise from scientific creativity, and the presentation humanizes the scientific process, revealing the extent to which great scientists were the first to consider the philosophical implications of their work. But, most significantly, the editors offer this as their central thesis: although each was ushered in by a revolution, and each contains counterintuitive elements that delayed its acceptance, these five theories exhibit a continuous rational development that has led them to a permanent place in the worldview of science. Accessible to the general reader yet sufficiently substantive that working scientists will find value in it, The Tests of Time offers an intimate look into how physical theory has been developed, by the brilliant people who have developed it. (shrink)

As has become tradition, executive directors of United States’ presidential bioethics committees offer reflections about their experience shortly after the orderly shutdown of the commission staff. After the records are filed according to government records regulations; after all the staff members, who are hired into temporary positions that must be renewed every two years, have secured permanent employment; after preparations are made to ensure that the next commission staff (should there be one) has a budget and standard operating procedures in (...) order to begin its work in a timely manner; after the lights are turned out for the last time, the executive director makes the final climb up the stairs into the sunlight and reflects on the whirlwind. There is much about my work with the Presidential Commission for the Study of Bioethical Issues that deserves comment, but one aspect of the commission that has been especially valuable to me is its work to educate the nation on bioethical issues. This is, moreover, a contribution in which the commission staff was central, and it is one that, as an ethics educator myself, I will cherish deeply. (shrink)

We present a case for defining objectivity as responsibility. We do not attempt to offer new arguments on epistemological issues such as relativism or the fact-value distinction. Instead, we construct a conception of objectivity utilizing analyses from Deweyan pragmatism, feminist theory, and science studies, organizing them around the concept of responsibility. This conception of objectivity can serve as a tool to guide the process of inquiry; by suggesting that participants reflect on the question "how can this inquiry be made more (...) responsible?" it provides a guide for those struggling with the question of how to be more objective. (shrink)

Reviews the role of intuition or an analogous concept within several divergent philosophical systems and argues that the salient feature common to various accounts of intuition is its non-inferential status. As such, it is argued to be highly relevant to contemporary theory. The paper offers several examples of points of compatibility with contemporary theory, including perception of social affordances, the apprehension linguistic rules and the construction of social norms. In claiming specific ways in which the concept of intuition is relevant (...) to contemporary theoretical psychology, the paper moves toward developing a more comprehensive and historically informed framework for intuition than is currently offered. It also underscores the historical underpinnings of contemporary debates. 2012 APA, all rights reserved). (shrink)

For the first time, the revised Common Rule specifies that public health surveillance activities are not research. This article reviews the historical development of the public health surveillance exclusion and implications for other foundational public health practices.

In this Article I argue that the emerging public/private nexus of surveillance involves the augmentation of state power and calls for new models of constitutional constraint. The key phenomenon is the role played by communications intermediaries in collecting the information that the state subsequently accesses. These intermediaries are not just powerful companies engaged in collecting and analyzing the information of users and the information they hold are not just business records. The key feature of these companies is that, through their (...) information practices and architecture, they mediate other relationships. I argue that this mediating function, and its underlying technological form, interacts with legal and social norms in ways that can lead to the erosion of constraints on state power. This Article maps two stories of erosion, rooted in two kinds of community displacement. The first involves the displacement of community participation in law enforcement and the emergence of “technological tattletales” where intermediaries cooperate with the state. Unlike citizen cooperation, this practice augments state power and undermines more traditional informal modes of constraint on state power. The second involves the displacement of national legal and political community. Communications intermediaries are often large multinational companies that operate in multiple jurisdictions and move their data to various datacenters across the world even as the individual data subject remains in one geographical location. Laws that treat nonresident aliens differently from residents and citizens can create “constitutional black holes” where the communications data of an individual is not protected by any constitutional constraints. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page W1-W3, August 2012.

This essay is a comparative analysis of results reported in this volume from studies in mainland China, the United States, Iran, and Hong Kong regarding organ donation incentives. They reveal widespread (but not unanimous) support for honorary incentives (such as notes or ceremonies of gratitude) and significant support for familist incentives (offering a donor’s family members priority should they need an organ transplant in the future). Opinions on financial incentives were much more mixed, with significant worries expressed regarding potential exploitation (...) and unfairness. These interviews also reinforce the importance of culturally appropriate constructions of any steps to increase organ donation rates. And, in addition to their comments on various types of incentive, interviewees in these chapters also offer insight into other measures that could be taken to increase organ donation. (shrink)

In _Law’s Rule_, Gerald Postema provides a robust theoretical framework of the rule of law that technology scholars can use to analyze power in the digital world. He articulates how the rule of law can be concerned with private power, and not just public power. His emphasis on the ethos of fidelity allows us to see how the rule of law of law may be degraded in the digital era through the erosion of the informal institutions and practices needed to (...) sustain the rule of law. In addition to outlining these contributions, this paper argues that Postema’s account of digital power needs to focus more on digital power structures rather than digital power wielding, that digital power structures erode many informal constraints on power, and that addressing sociotechnical systems might require rethinking law’s distinctive instrumentalities in order to embrace the use of digital technologies to increase transparency and compliance. (shrink)

Rational Intuition explores the concept of intuition as it relates to rationality through mediums of history, philosophy, cognitive science, and psychology.

It is not clear whether breast cancer screening is a public health intervention or an individual clinical service. The question is important because the concepts best suited for ethical reasoning in public health might be different to the concepts commonly employed in biomedical ethics. We consider it likely that breast screening has elements of a public health intervention and used an empirical ethics approach to explore this further. If breast screening has public health characteristics, it is probable that policy and (...) practice experts will employ socially embedded concepts when reasoning about it. We gathered data on whether and how these concepts existed in the discussion and reasoning of Australian breast screening experts. We found that experts employed these concepts when talking about the purpose and practices of breast screening, and the behaviour of breast screening professionals and consumers. Experts gave varied judgements about breast screening based on reasoning with these concepts, considering it to be more or less successful in contributing to the public interest and in incorporating socially embedded concepts into its operational agenda. Our findings are compatible with breast screening having public health characteristics. We advocate for the incorporation of socially embedded concepts in breast screening policy and practice. (shrink)