As part of an extended participant observation study of hospice, I present in this article some reflections on my first experiences as a hospice volunteer. Discussion of these experiences emphasizes the influences of my own socialization, but suggests the types of filters trough which people often see and behave in the world of the dying and beyond.

This paper is an indirect critique of the practice of American liberal education. I show that the liberal, integrative model that American colleges and universities have adopted, with one key exception, is essentially an approach to education proposed some 2400 years ago by Stoic philosophers. To this end, I focus on a critical sketch of the Stoic model of education—chiefly through the works of Seneca, Epictetus, and Aurelius—that is distinguishable by these features: education as self‐knowing, the need of logic and (...) critical thinking for informed decision‐making, learning as preparation for life, and knowledge for integration in private, local, and global affairs. Such a critical sketch may not only help institutions instantiate their own similar aims more effectively, but also help them assess those aims with apposite normative force, which today they lack. (shrink)

The importance of preserving trust in physicians and in medical institutions has received widespread attention in recent years. Primarily, this is due to the threats to trust posed by managed care, but there is a general and growing recognition that trust deserves more attention than it traditionally has received in all aspects of medical ethics, law, and public policy. Trust has both intrinsic and instrumental value. Trust is intrinsically important because it is a core characteristic that affects the emotional and (...) interpersonal aspects of the physician/patient relationship. As an instrumental value, trust is widely believed to be essential for effective therapeutic encounters. It has been hypothesized or shown to affect a host of important behaviors and attitudes relating to care, including seeking care, disclosing private information, complying with treatment, and being satisfied with care. Moreover, trust may be a mediator of measurable clinical outcomes and a key factor in the mind–body interactions that underlie placebo/nocebo effects and the effectiveness of alternative medicine. It is no surprise, then, that preserving, justifying, and enhancing trust is the fundamental goal of much of medical ethics, and is a prominent objective in healthcare law and public policy. Discussions of trust and related concepts were commonplace in professionally based medical ethics prior to the 1970s. a 1 2. (shrink)

Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, 501 East Broadway # 310, Louisville, Kentucky 40202, USA. Tel.: 502 852 4980; Fax: 502 852 4963; Email: mark.rothstein{at}louisville.edu ' + u + '@' + d + ' '//--> Abstract In his article in this issue, Daniel Goldberg advocates a broad definition of public health and expressly rejects the narrow definition of public health I proposed in (...) a 2002 article. Goldberg asserts that public health should include all of the root causes of ill health in populations. Such a definition, however, would include within public health war, famine, crime, illiteracy and numerous other conditions on which public health professionals and agencies lack the resources, expertise and public support to act. The appropriate definition explicitly recognizes that public health is a legal term of art referring to specifically authorized activities by public officials to protect, promote and improve population health. CiteULike Connotea Del.icio.us What's this? (shrink)

This article is an extended commentary inspired by Alan Drengson's paper “Shifting Paradigms: From Technocrat to Planetary Person” (Drengson 2011). In this article Susan Greenwood and I echo Drengson's criticism that Euro-American science is incomplete, having committed what Thomas Roberts calls “The Singlestate Fallacy: the erroneous assumption that all worthwhile abilities reside in our normal, awake mindbody state” (Roberts 2006:105). This singlestate fallacy is vividly portrayed in Mary Shelley's novel Frankenstein, whose critique of Euro-American science is revisited in this article. (...) Alternatively, Greenwood and I suggest that what is needed is a multimodel framework “that allows for in-depth analysis of the different modes of consciousness.” Roberts refers to this alternative attitude toward science as the Multistate Paradigm. An awareness of the transformational character of shamanism is also explored in this article as a means to overcome the oppositions between the technocratic and person planetary perspective, and their related gender associations. (shrink)

Each year individuals are required to execute millions of authorizations for the release of their health records as a condition of employment, applying for various types of insurance, and submitting claims for benefits. Generally, there are no restrictions on the scope of information released pursuant to these compelled authorizations, and the development of a nationwide system of interoperable electronic health records will increase the amount of health information released. After quantifying the extent of these disclosures, this article discusses why it (...) is important to limit disclosures of health information for nonmedical purposes as well as how it may be possible to do so. (shrink)

For fifty years Hubert Dreyfus has done pioneering work which brings phenomenology and existentialism to bear on the philosophical and scientific study of the mind. This is a selection of his most influential essays, developing his critique of the representational model of the mind in analytical philosophy of mind and mainstream cognitive science.

Prompted by the development of the Theory of Challenge and Threat States in Athletes (Jones et al, 2009), recent years has witnessed a considerable increase in research examining challenge and threat in sport. This manuscript provides a critical review of the literature examining challenge and threat in sport, tracing its historical development and some of the current empirical ambiguities. In an attempt to reconcile some of these ambiguities, and utilising neurobiological evidence associated with approach- and avoidance-motivation (cf. Elliot & Covington, (...) 2001), this paper draws upon the Evaluative Space Model (ESM: Cacioppo et al., 1997) and considers the implications for understanding challenge and threat in sport. For example, rather than see challenge and threat as opposite ends of a single bipolar continuum, the ESM implies that individuals could be (1) challenged, (2) threatened, (3) challenged and threatened, or (4) neither challenged or threatened by a particular stimulus. From this perspective it could be argued that the appraisal of some sport situations as both challenging and threatening could be advantageous, whereas the current literature seems to imply that the appraisal of stress as a threat is maladaptive for performance. In drawing upon the ESM, we outline the Evaluative Space Approach to Challenge and Threat and provide several testable hypotheses for advancing understanding of challenge and threat (in sport). We also outline a number of cardiovascular and experiential measures that can be used to examine these hypotheses. In sum, this paper provides a significant theoretical, empirical and practical contribution to our understanding of challenge and threat (in sport). (shrink)

Researchers increasingly rely on large data sets of health information, often linked with biological specimens. In recent years, the argument has been made that obtaining informed consent for conducting records-based research is unduly burdensome and results in ?consent bias.? As a type of selection bias, consent bias is said to exist when the group giving researchers access to their data differs from the group denying access. Therefore, to promote socially beneficial research, it is argued that consent should be unnecessary. After (...) analyzing the biostatistics evidence and bioethics arguments, the article concludes that (1) claims about the amount of consent bias are overstated; (2) commonly used statistical methods usually can account for consent bias; and (3) any residual effects of consent bias are below an acceptable level of imprecision and constitute a reasonable social cost for conducting ethically responsible research. (shrink)

Weak emergence is the view that a system’s macro properties can be explained by its micro properties but only in an especially complicated way. This paper explains a version of weak emergence based on the notion of explanatory incompressibility and “crawling the causal web.” Then it examines three reasons why weak emergence might be thought to be just in the mind. The first reason is based on contrasting mere epistemological emergence with a form of ontological emergence that involves irreducible downward (...) causation. The second reason is based on the idea that attributions of emergence are always a reflection of our ignorance of non-emergent explanations. The third reason is based on the charge that complex explanations are anthropocentric. Rather than being just in the mind, weak emergence is seen to involve a distinctive kind of complex, macro-pattern in the mind-independent objective micro-causal structure that exists in nature. The paper ends by addressing two further questions. One concerns whether weak emergence applies only or mainly to computer simulations and computational systems. The other concerns the respect in which weak emergence is dynamic rather than static. (shrink)

Ligation is a form of chemical self-assembly that involves dynamic formation of strong covalent bonds in the presence of weak associative forces. We study an extremely simple form of ligation by means of a dissipative particle dynamics (DPD) model extended to include the dynamic making and breaking of strong bonds, which we term dynamically bonding dissipative particle dynamics (DDPD). Then we use a chemical genetic algorithm (CGA) to optimize the model’s parameters to achieve a limited form of ligation of trimers—a (...) proof of principle for the evolutionary design of self-assembling chemical systems. (shrink)

Abstract:Moral imagination is a reasoning process thought to counter the organizational factors that corrupt ethical judgment. We describe the psychology of moral imagination as composed of the four decision processes identified by Rest (1986), i.e., moral sensitivity, moral judgment, moral intention, and moral behavior. We examine each process in depth, distilling extant psychological research and indicating organizational implications. The conclusion offers suggestions for future research.The majority of men are subjective toward themselves and objective toward all others—terribly objective sometimes—but the real (...) task is in fact to be objective toward one’s self and subjective toward all others. (shrink)

For nearly twenty-five years, federal regulation of privacy issues in research involving human subjects was the primary province of the federal rule for Protection of Human Subjects. As of April 14, 2003, the compliance date for the Privacy Rule of the Health Insurance Portability and Accountability Act, however, the Common Rule and the Privacy Rule jointly regulate research privacy. Although, in theory, the Privacy Rule is intended to complement the Common Rule, there are several areas in which the rules diverge. (...) In some instances the inconsistencies result in gaps in privacy protection; in other instances the inconsistencies result in added burdens on researchers without additional privacy protections. In all instances, the lack of harmonization of these rules has created confusion, frustration, and misunderstanding by researchers, research subjects, and institutional review boards. In this article, I review the major provisions of the Privacy Rule for research, explain the areas in which the Privacy Rule and Common Rule differ, and conclude that the two rules should be revised to promote consistency and maximize privacy protections while minimizing the burdens on research. (shrink)

In 2018, the remarkable rescue of twelve young boys and their football coach trapped in a flooded cave in Thailand captured worldwide attention. The rescue required the boys to be dived out of the cave system while fully anaesthetized which presented unique practical and ethical challenges for the rescue team. Major departures from normal anaesthetic practice were required. Taking anaesthetized children underwater was unprecedented, complex, and dangerous. To do this underground in a flooded cave meant the risks were extreme. Using (...) a principlist approach, this essay will outline the rescue plan highlighting the ethical dilemmas faced by the rescue team. Informed consent and full disclosure of information are justifiably waived in emergency disaster scenarios. Beneficence as a guiding principle becomes a major challenge when all rescue options appear destined to cause likely fatalities of healthy young boys. Importantly, virtues and virtue ethics also have a vital role to play when confronting and dealing with ethical challenges in disaster scenarios—this will be discussed with particular reference to the cave rescue. (shrink)

This paper investigates the semantic treatment of conditional obligation, explicit permission (often called positive permission), and prohibition based on models with agents and branched time. In such models branches (rather than moments) are taken as basic, and the branching provides a way to represent the indeterminism which is normally presupposed by talk of free will, responsibility, action and ability. Careful treatment of the relation between ability and responsibility avoids many common problems with accounts of conditional obligation. Recognition of the generality (...) often involved in conditional obligations makes possible a sensitive way of expressing some kinds of general prohibitions, which in turn makes it possible to account for the special role of explicit permission. (shrink)

Recollections of humanistic and transpersonal psychology’s origin’s morph into the pros and cons of humanistic/transpersonal oriented schools developing APA accredited clinical programs. This discussion dovetails with the question will ATP ever become an APA division, raising an interesting alternative for those of us considering a career in counseling: becoming a spiritual coach. Enter the issue of psychedelic therapy and the Supreme Courts decision to allow ayahuasca as a sacrament by the Uniao Do Vegetal Church, and the importance of why humanistic (...) and transpersonal psychology need to clearly map out the territories and sub-divisions of science and religion. Finally this conversation raises a concern, that Maslow’s call for a “trans-human” psychology sought to encourage creating what we now call ecopsychology. (shrink)

The HIPAA Privacy Rule is notoriously weak because of its incomplete coverage, numerous exclusions and exemptions, and limited rights for individuals. The three areas in which it provides the most protection are fundraising, marketing, and research. Provisions of the 21st Century Cures Act, pending in Congress, and the Notice of Proposed Rulemaking to amend the federal research regulations, awaiting final regulatory action, would weaken the privacy protections for research. If these measures are adopted, the HIPAA Privacy Rule would have so (...) little value that it might not be worth the aggravation and burden. (shrink)

New developments in genetics could affect a variety of real property rights. Mortgage lenders, mortgage insurers, real estate sellers, senior living centers, retirement communities, or other parties in residential real estate transactions begin requiring predictive genetic information as part of the application process. One likely use would be by retirement communities to learn an individual's genetic risk for Alzheimer's disease. The federal Fair Housing Act prohibits discrimination based on disability, but it is not clear that it would apply to genetic (...) risk assessments. Only California law explicitly applies to this situation and there have been no reported cases. (shrink)

This book explores the making of health care rationing decisions through the analysis of three alternative decision makers: patients paying out of pocket; officials setting limits on treatments and coverage; and physicians at the bedside. Hall develops this analysis along three dimensions: political economics, ethics, and law. The economic dimension addresses the practical feasibility of each method. The ethical dimension discusses the moral aspects of these methods, while the legal dimension traces the most recent developments in jurisprudence and health law.

Wie geartet ist das Verhältnis zwischen den zentralen Begriffen „Bewußtsein“ und „Reflexion“ in Lockes Essay? Sind diese Begriffe für Locke identisch oder voneinander verschieden? Falls sie verschieden sind, wie ist der Unterschied genau zu bestimmen? Diese Arbeit untersucht die Fragen, unter Berücksichtigung der unterschiedlichen Deutungen in der Sekundärliteratur; sie sichtet und prüft den Text des Essays sorgfältig und breitet ein breites Spektrum philosophischer Implikationen von Lockes Ausführungen über das „Bewußtsein“ und „Reflexion“ aus. Der abschließende Teil legt dar, daß Locke niemals (...) eine feste Position gegenüber dem Verhältnis zwischen den beiden Begriffen eingenommen hat, sondern daß er zwischen verschiedenen Positionen schwankte -als Resultat der starken philosophischen Kräfte, die ihn bald in die eine, bald in die andere Richtung zogen. (shrink)

For more than a quarter of a century, Hubert L. Dreyfus has been the leading voice in American philosophy for the continuing relevance of phenomenology, particularly as developed by Edmund Husserl, Martin Heidegger, and Maurice Merleau-Ponty. Dreyfus has influenced a generation of students and a wide range of colleagues, and these volumes are an excellent representation of the extent and depth of that influence.In keeping with Dreyfus's openness to others' ideas, many of the essays in this volume take the form (...) of arguments with various of his positions. The essays focus on the dialogue with the continental philosophical tradition, in particular the work of Heidegger, that has played a foundational role in Dreyfus's thinking. The sections are Philosophy and Authenticity; Modernity, Self, and the World; and Heideggerian Encounters. The book concludes with Dreyfus's responses to the essays.Contributors : William D. Blattner, Taylor Carman, David R. Cerbone, Dagfinn Føllesdal, Charles Guignon, Michel Haar, Beatrice Han, Alastair Hannay, John Haugeland, Randall Havas, Jeff Malpas, Mark Okrent, Richard Rorty, Julian Young, Michael E. Zimmerman. (shrink)

The Rationality Principle says that people act adequately to their situation, but does not specify how they must act in order to do so. Situational Analysis uses the Rationality Principle, together with a model of the social situation, to explain actions in the past. Unlike Rational Choice Theory, Situational Analysis does not try to predict or influence actions in the future. Popper regarded the Rationality Principle as false, but thought that we should use it nonetheless. This poses a problem for (...) understanding his views about conjecture and refutation. Popper, however, thought that all scientific models are false, and that whether or not we should reject a model depends on the problem that we are trying to solve. (shrink)

Calling for an expanded framework of EuroAmerican science's methodology whose perspective acknowledges both quantitative/etic and qualitative/emic orientations is the broad focus of this article. More specifically this article argues that our understanding of shamanic and/or other related states of consciousness has been greatly enhanced through ethnographic methods, yet in their present form these methods fail to provide the means to fully comprehend these states. They fail, or are limited, because this approach is only a “cognitive interpretation” or “metanarrative” of the (...) actual experience and not the experience itself. Consequently this perspective is also limited because the researcher continues to assess his or her data through the lens of their symbolic constructs, thereby preventing them from truly experiencing shamanic and psi/spirit approaches to knowing since the data collection process does not “in and of itself” affect the observer. We, therefore, need expanded ethnographic methods that include within their approaches an understanding of methods and techniques to experientially encounter these states of consciousness—and become transformed by them. Our becoming transformed and then recollecting our ethnoautobiographical experiences is the means toward a new kind of science and its methods of inquiry that this article seeks to encourage. (shrink)

In the early 1970s, Congress considered enacting comprehensive privacy legislation, but it was unable to do so. In 1974, it passed the Privacy Act, applicable only to information in the possession of the federal government. In the intervening years, other information privacy laws enacted by Congress, such as the Health Insurance Portability and Accountability Act, have been weak and sector specific. With the explosion of information technology and the growing concerns about an absence of effective federal privacy laws, the legal (...) focus has shifted to the states. Signaling a new direction in state data privacy and consumer protection law, the California Consumer Privacy Act establishes important rights and protections for California residents with regard to the collection, use, disclosure, and sale of their personal information. The CCPA is certain to spur similar legislation and to affect national and international businesses that collect data from California's residents. Understanding the new law is important for all data‐driven industries, including health care. (shrink)

Stephens and Feezell argue, in?The Ideal of the Stoic Sportsman?, that?one need not be a scholar of ancient Greek philosophy to refer to?stoic? conduct or a?stoic? approach to certain matters, because the vocabulary related to this apparently antiquarian view of life has seeped into our common language?. Nonetheless, Stephens and Feezell go on to give a scholarly account of Stoicism as it relates to athletic participation. Their account, in part, takes the form of a distinction between?simple Stoicism? and?sophisticated Stoicism?? the (...) former being a common, contemporary grasp of Stoic moral psychology; the latter being a more sophisticated and historically accurate grasp of Stoic moral psychology. In fleshing out their more sophisticated account, they disclose a paradox. Given the Stoic sufficiency thesis? i.e., that the sole good is virtue? the Stoic sportsman must be indifferent to failure or winning. Yet the Stoic sportsman must be sufficiently attached to the athletic experience to use it as a means of developing virtuous states of character. That they dub the paradox the?paradox of Stoic detachment?.?Curiosity? Paradox? Or psychological incoherence?? they ask. The aim of the present undertaking is a?soft? critique of Stephens and Feezell? soft, because the critique is not so much a critical rejection of the authors' view tout court. Instead, I aim to point out deficiencies with their account and expand on other points not fully elucidated in it. The most salient point I make is that what they deem paradoxical is not really paradoxical, once there is a more thorough account and clearer grasp of Stoic?detachment? (shrink)

Numerous state laws and the federal Genetic Information Nondiscrimination Act (GINA) have been enacted to prevent or redress genetic discrimination in employment and health insurance, but laws protecting against genetic discrimination in life insurance have been less common and weak. Consequently, some individuals with a genetic risk of a serious illness have declined presymptomatic genetic testing, thereby decreasing their prevention and treatment options and increasing their mortality risk. In 2020, Florida became the first state to prohibit life insurance companies from (...) using the results of presymptomatic genetic tests in underwriting. Although the law was “only” intended to prevent genetic discrimination, a possible or even likely consequence of the law will be to encourage timely genetic testing by at‐rick individuals and thereby save lives. (shrink)

We demonstrate a method for optimizing desired functionality in real complex chemical systems, using a genetic algorithm. The chemical systems studied here are mixtures of amphiphiles, which spontaneously exhibit a complex variety of self-assembled molecular aggregations, and the property optimized is turbidity. We also experimentally resolve the fitness landscape in some hyper-planes through the space of possible amphiphile formulations, in order to assess the practicality of our optimization method. Our method shows clear and significant progress after testing only 1 % (...) of the possible amphiphile formulations. (shrink)

This book includes ten essays that trace the notion of unconcealment as it develops from Heidegger's early writings to his later work, shaping his philosophy of truth, language and history. 'Unconcealment' is the idea that what entities are depends on the conditions that allow them to manifest themselves. This concept, central to Heidegger's work, also applies to worlds in a dual sense: first, a condition of entities manifesting themselves is the existence of a world; and second, worlds themselves are disclosed. (...) The unconcealment or disclosure of a world is the most important historical event, and Heidegger believes there have been a number of quite distinct worlds that have emerged and disappeared in history. Heidegger's thought as a whole can profitably be seen as working out the implications of the original understanding of unconcealment. (shrink)