As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive (...) alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual‐ or gender‐minority groups who likewise seek to pursue parenthood. We examine the history of access to current family‐building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual‐ or gender‐minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice. (shrink)

Les études sur l’Obéissance à l’Autorité (OtA) de Milgram ont depuis longtemps été comprises comme démontrant que les gens ont une tendance à suivre aveuglément les ordres de l’autorité. Plus récemment, nous avons proposé un modèle d’obéissance basé sur le suivisme engagé (engaged followership), qui suggère que la décision d’une personne d’accepter les requêtes d’une figure d’autorité est basée sur son identification avec cette personne et/ou la cause qu’elle représente. Dans cet article, nous présentons nos raisons de soutenir cette perspective (...) et faisons le point sur les éléments empiriques dont nous disposons actuellement pour la soutenir. Nous indiquons également quelles questions restent posées, et posons ainsi les bases d’un programme pour des recherches futures. (shrink)

The lymphatic vasculature plays a critical role in the regulation of body fluid volume and immune function. Extensive research into the molecular mechanisms that control blood vessel growth has led to identification of molecules that also regulate development and growth of the lymphatic vessels. This is generating a great deal of interest in the molecular control of the lymphatics in the context of embryogenesis, lymphatic disorders and tumor metastasis. Studies in animal models carried out over the past three years have (...) shown that the soluble protein growth factors, vascular endothelial growth factor (VEGF)‐C and VEGF‐D, and their cognate receptor tyrosine kinase, VEGF receptor‐3 (VEGFR‐3), are critical regulators of lymphangiogenesis. Furthermore, disfunction of VEGFR‐3 has recently been shown to cause lymphedema. The capacity to induce lymphangiogenesis by manipulation of the VEGF‐C/VEGF‐D/VEGFR‐3 signaling pathway offers new opportunities to understand the function of the lymphatic system and to develop novel treatments for lymphatic disorders. BioEssays 24:1030–1040, 2002. © 2002 Wiley‐Periodicals, Inc. (shrink)

In early 2013, the Indian government introduced new rules governing the conduct of clinical trials involving human participants. Among other provisions, the law requires that sponsors of research compensate participants who are injured during the course of their research participation. This article examines the effects of India's compensation law and the efforts that policymakers in India have made to tailor the law since its passage. I use the legal concept of acoustic separation as a framework to explain and justify the (...) approach that India has taken in refining its regulation of research related injuries. I conclude that India's example may provide useful lessons for research sponsors and lawmakers in other regulatory states seeking to promote a well-regulated biomedical research industry. (shrink)

The ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using a stratified (...) purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)

Growth of the Hispanic consumer population in America is changing the marketplace landscape. Due to their considerable buying power, a better understanding of Hispanic consumer behavior has become a necessity. The marketing literature has examined issues regarding religiosity and attitude toward business in regards to consumer ethical beliefs as well as research differentiating consumers on the basis of ethnicity due to their inherently different religious principles. Therefore, the present study contributes to the existing consumer ethics literature by examining the roles (...) of religiosity and attitude toward business in determining consumer ethical beliefs. Furthermore, this study compares the relationships among religiosity, attitude toward business, and ethical beliefs at the sub-cultural level (i.e., between Hispanic and Anglo-American consumers). Survey data compare a sample of 187 predominately Catholic Hispanic consumers with a sample of 127 predominately protestant Anglo consumers. Results suggest a positive relationship between intrinsic religiousness and beliefs that questionable consumer activities are unethical. However, extrinsic religiousness does not impact consumer views as to the ethicality of consumer practices. Hispanics exhibit higher levels of extrinsic religiousness than Anglos, but no difference in terms of their intrinsic religiousness. Results also suggest that Hispanics have a more negative attitude toward business than Anglos do. Implications of these results are discussed. (shrink)

The process of dehumanization, or thinking of others as less than human, is a phenomenon with significant societal implications. According to Haslam's model, two concepts of humanness derive from comparing humans with either animals or machines: individuals may be dehumanized by likening them to either animals or machines, or humanized by emphasizing differences from animals or machines. Recent work in cognitive neuroscience emphasizes understanding cognitive processes in terms of interactions between distributed cortical networks. It has been found that reasoning about (...) internal mental states is associated with activation of the default mode network and deactivation of the task positive network ; whereas reasoning about mechanical processes produces the opposite pattern. We conducted two neuroimaging studies. The first examined the neural bases of dehumanization and its relation to these two brain networks, using images and voice-over social narratives which either implicitly contrasted or implicitly likened humans to either animals or machines. The second study addressed a discrepancy between findings from the first study and prior work on the neural correlates of dehumanization: using a design similar to prior work we examined neural responses to pictures of humans, animals and machines, presented without any social context. In both studies, human and humanizing conditions were associated with relatively high activity in the DMN and relatively low activity in the TPN. However, the non-human and dehumanizing conditions deviated in different ways: they demonstrated more marked changes either in the DMN or in the TPN. Notably, differences between the animal dehumanizing and humanizing conditions were most evident in regions associated with mechanistic reasoning, not in the mentalizing network. Conjunction analysis of contrasts from both paradigms revealed that only one region was consistently more active when participants saw human, a medial parietal region regarded as the central hub of the DMN. These findings provide a neural basis for Haslam's distinction between two types of dehumanization, and suggest that the DMN and TPN play opposing roles in creating a sense of moral concern. (shrink)

Dementia is a growing issue at the end of life that presents unique challenges for advance care planning. Advance directives are a useful and important component of end-of-life planning, but standard advance directives have less utility in cases of loss of capacity due to dementia. An advance directive designed to specifically address end-of-life issues in the setting of dementia can provide patients with increased autonomy and caregivers with improved information about the desires of the individual in question. The Dartmouth Dementia (...) Directive is a dementia-specific advance directive, available online, that seeks to address common concerns of individuals who are planning for dementia-related end-of-life care. This directive was piloted in a community-based workshop, which provided important details and perspective on the best use of dementia-specific advance directives in the greater population. (shrink)

Research on escalation of commitment has predominantly been studied in the context of a single decision without consideration for the psychological consequences of escalating. This study sought to examine a) the extent to which people escalate their commitment to a failing course of action in a sequential decision-making task, b) confidence and anger as psychological consequences of escalation of commitment, and c) the reciprocal relationship between escalation of commitment and confidence and anger. Participants were 110 undergraduate students who completed a (...) series of investment decisions regarding a failing endeavor. Results revealed that although a high proportion of individuals escalate through all decisions, the extent to which they escalated decreased with each decision as they were less willing to invest money in the project. Furthermore, as participants escalated, confidence in one’s decision decreased and anger increased. Lastly, the analyses revealed that the relationship between escalation and confidence is reciprocal. Escalation was negatively associated with confidence, and confidence predicted escalation in the subsequent decision. These results highlight the importance of considering both the determinants and psychological consequences of escalation of commitment. (shrink)

Despite the growing body of literature on training in the responsible conduct of research, few studies have examined the effectiveness of delivery formats used in ethics courses. The present effort sought to address this gap in the literature through a meta-analytic review of 66 empirical studies, representing 106 ethics courses and 10,069 participants. The frequency and effectiveness of 67 instructional and process-based content areas were also assessed for each delivery format. Process-based contents were best delivered face-to-face, whereas contents delivered online (...) were most effective when restricted to compliance-based instructional contents. Overall, hybrid courses were found to be most effective, suggesting that ethics courses are best delivered using a blend of formats and content areas. Implications and recommendations for future development of ethics education courses in the sciences are discussed. (shrink)

'Tu m'as déçu!' Qui, aujourd'hui, pourrait se relever d'une telle accusation? Et qui, aussi, n'y a jamais recouru? Nous sommes les êtres de la déception, car nous ne cessons de décevoir et d'être déçu. Pourtant, les moralistes l'ont martelé : être déçu, c'est avant tout être la victime d'attentes qui n'existaient que dans notre tête. Mais si ce n'était pas tout? Et si, derrière la fable morale, se dissimulait toute une politique, une théologie et même une métaphysique? Et si, derrière (...) la danse de l'espoir et de la déception, des attentes et de leur frustration, se déployait un véritable ordre du monde, décidant, pour nous, de ce que nous pouvons et ne pouvons pas? Et si décevoir était avant tout une manière de s'y soustraire? Poursuivant son travail de décadrage des grands concepts issus de la modernité, Laurent de Sutter ajoute un chapitre jouissif au chantier de ses Propositions."--Page 4 of cover. (shrink)

The integration of multisensory information is an essential mechanism in perception and action control. Research in multisensory integration is concerned with how the information from the different sensory modalities, such as the senses of vision, hearing, smell, taste, touch, and proprioception, are integrated to a coherent representation of objects (for an overview, see e.g., Calvert, Spence and Stein, 2004). The combination of information from the different senses is central for action control. For instance, when you grasp for a rubber duck, (...) you can see its size, feel its compliance and hear the sound it produces. Moreover, identical physical properties of an object can be provided by different senses. You can both see and feel the size of the rubber duck. Even when you grasp for the rubber duck with a tool (e.g., with tongs), the information from the proximal hand, from the effective part of the distal tool and from the eyes are integrated in a manner to act successfully (for limitations of this integration see Sutter et al., 2013).Over the recent decade a surge of interest in multisensory integration and action control has been witnessed, especially in connection with the idea of a statistically optimized integration of multiple sensory sources. The human information processing system is assumed to adjust moment-by-moment the relative contribution of each sense’s estimate to a multisensory task. The sense’s contribution depends on its variance, so that the total varia... (shrink)

In this target article by Morain and Largent (2023), the authors focus on an investigator’s duty to patient-subjects specifically regarding incidental or collateral findings within the context of e...

In their target article, Conley et al. (2023) appropriately highlight the ongoing conceptual and practical opacity of public engagement (PE) in the translation of human gene editing (HGE) (Conley e...

"Pop'philosophie" : si l'on en croit la morgue méprisante que ce simple mot provoque, il s'agirait du nom d'une étrange maladie. Celle d'une philosophie se prostituant aux industries culturelles ou, pire, aux sirènes du populisme. Avec la pop' philosophie, on assisterait à la ruine de la philosophie tout court, devenue tantôt gadget pédagogique, tantôt tentative pathétique de capitaliser sur le glamour frelaté de la pop culture. Et si c'était faux? Pour Gilles Deleuze, en tout cas, rien n'était plus important que (...) l'invention d'une pop'philosophie qui sauverait la pensée de la correction professorale et de la pontification esthétique. Inventer une pensée véritablement anarchiste, enterrant la philosophie pour l'ouvrir à des devenirs inédits : tel était l'objectif qu'il donna au concept de pop'philosophie. Rien n'était moins simple ni plus ambitieux. Il est temps de comprendre en quoi."--Page 4 of cover. (shrink)

In a series of writings, the Australian philosopher Janna Thompson (1942 - 2022) developed a political ethics of intergenerational justice. She combines the responsibilities of the present in regard of the injustice of previous generations with the responsibilities of the present for the injustice to those not yet born. Her political ethics of intergenerational justice contains an argument for the justification of intergenerational care and responsibility, which is based on vulnerability and dependency in intergenerational practices. It criticises the notion of (...) future generations as unconnected, as yet non-existent individuals and instead describes society as a diachronic continuum of interdependent members of overlapping, interconnected generations whose members share duties and responsibilities for predecessors and successors. This article attempts to reconstruct Thompson's argument for "temporal vulnerability", i.e. for the justification of a responsibility for the well-being of unborn future generations, in the context of climate ethics. At the centre are not only the actions or decisions that are subject to norms, or the rights of future generations, but social practices that, by continuing collectively, contain a material normativity in the present from the future. The duties of the present can be recognized by examining whether these practices are justifiable vis-à-vis the future. These are duties of care and responsibility that arise from intergenerational relationships. This argument is confronted with two questions: 1) Does its validity depend, as Thompson seems to suggest, on presuppositions of a contract theory of justice? 2) How strong seems the normative binding force that emanates from her argument and how does this binding force work? Through her diachronic approach, Thompson offers an approach to intergenerational justice that looks both backwards into the past and forward into the future, leading to a nuanced understanding of the responsibility of the present generation living in structures already established by previous generations. Their responsibility can be specified in terms of what is in their power to do to stop a harmful dynamic. (shrink)

The routinization of prenatal diagnosis is the source of bioethical and policy debates regarding choice, autonomy, access, and protection. To understand these debates in the context of cultural diversity and moral pluralism, we compare Israel and Germany, focusing on two recent repro-genetic “hot spots” of such policy-making at the beginning of life: pre-implantation genetic diagnosis and non-invasive prenatal genetic testing, two cutting-edge repro-genetic technologies that are regulated and viewed very differently in Germany and Israel, reflecting different medicolegal policies as well (...) as public and bioethical considerations. First, we compare policy-making in the context of PGD for HLA typing, used to create sibling donors, approved in Israel under specific conditions while prohibited in Germany. Second, we compare policy-making in the context of NIPT, which came under fire in Germany, while in Israel there has been little public debate about it. Both countries justify their contrasting policies as reflecting a concern for the well-being and care of the embryo/child, thus highlighting different concepts of embryo/child protection, autonomy, family relations, and the impact of religion and history on the promotion/protection of life. We use the juxtaposition of PGD and NIPT to highlight some inconsistencies in policies concerning the protection of extra- and intra-corporeal embryos. We conclude by drawing on the comparison to show how national variations exist alongside co-evolution. (shrink)

Ethics courses are most commonly evaluated using reaction measures. However, little is known about the specific types of reaction data being collected and how these reaction data relate to improvements in trainee performance. Using a sample of 381 ethics training sessions, major reaction data categories were identified. Content and course satisfaction were the most frequently collected types of reaction criteria. Furthermore, content relevance and course satisfaction showed strong, positive relationships with performance criteria, whereas content satisfaction demonstrated a moderate, negative relationship. (...) These results and future directions for ethics training evaluation are discussed. (shrink)

Despite considerable scientific progress and the evolution of regulatory pathways to ensure safety and efficacy, US healthcare continues to see increasing health disparities. This suggests that clinical translation in of itself cannot be the only measure of its own success, especially when the most marginalized patients, are neglected in the development and implementation of medical innovations. This raises the question of whether a system that is narrowly focused on technical achievement can meet the moral obligations of medicine and public health. (...) We argue that traditional technocratic standards are failing to integrate normative considerations into biomedical translation. What is needed is a translational domain that moves beyond safety and efficacy toward anticipating how proposed technologies will be effective in society as it exists. We propose an additional metric of success: translational justice. (shrink)

In our article, we share the lessons we have learned after creating and running a successful legal laboratory over the past seven years at Yale Law School. Our legal laboratory, which focuses on the intersection of law and severe brain injury, represents a unique pedagogical model for legal academia, and is closely influenced by the biomedical laboratory.

According to a recent survey by the HR Research Institute, as the presence of artificial intelligence (AI) becomes increasingly common in the workplace, HR professionals are worried that the use of recruitment algorithms will lead to a “dehumanization” of the hiring process. Our main goals in this paper are threefold: i) to bring attention to this neglected issue, ii) to clarify what exactly this concern about dehumanization might amount to, and iii) to sketch an argument for why dehumanizing the hiring (...) process is ethically suspect. After distinguishing the use of the term “dehumanization” in this context (i.e., removing the human presence) from its more common meaning in the interdisciplinary field of dehumanization studies (i.e., conceiving of other humans as subhuman), we argue that the use of hiring algorithms may negatively impact the employee-employer relationship. We argue that there are good independent reasons to accept a substantive employee-employer relationship, as well as an applicant-employer relationship, both of which are consistent with a stakeholder theory of corporate obligations. We further argue that dehumanizing the hiring process may negatively impact these relationships because of the difference between the values of human recruiters and the values embedded in recruitment algorithms. Drawing on Nguyen’s (2021) critique of how Twitter “gamifies communication”, we argue that replacing human recruiters with algorithms imports artificial values into the hiring process. We close by briefly considering some ways to potentially mitigate the problems posed by recruitment algorithms, along with the possibility that some difficult trade-offs will need to be made. (shrink)

In this paper, we examine how the availability of massive quantities of data i.e., the “Big Data” phenomenon, contributes to the creation, spread, and harms of online misinformation. Specifically, we argue that a factor in the problem of online misinformation is the evolved human instinct to recognize patterns. While the pattern-recognition instinct is a crucial evolutionary adaptation, we argue that in the age of Big Data, these capacities have, unfortunately, rendered us vulnerable. Given the ways in which online media outlets (...) profit from the spread of misinformation by preying on this pattern-finding instinct, we conceptualize the problem that we identify as a morally objectionable form of “epistemic exploitation.” As we argue, the consumer of digital misinformation is often exploited by having her pattern-recognition instinct used against her. This exploitation is morally objectionable because it deprives her of an epistemic good to which she has a right. This epistemic good is the integrity of the pattern-recognition instinct itself which, we argue, is a capacity that allows us to participate in uniquely human goods. While our primary goal is to bring attention to this form of epistemic exploitation, we conclude by briefly evaluating some general solutions to the growing problem of online misinformation. (shrink)

Elizabeth Lanphier and Uchenna E. Anani provide a powerful argument for the value of a trauma-informed approach to the ethics consultation, which acknowledges the perspectives of all stakeho...

This paper takes up the question of how videographic public announcements (VPAs)---i.e. videos that a wide swath of the public sees and knows that everyone else can see too--- have functioned to mobilize people politically, and how the presence of deepfakes in our information environment stands to change the dynamics of this mobilization. Existing work by Regina Rini, Don Fallis and others has focused on the ways that deepfakes might interrupt our acquisition of first-order knowledge through videos. But I point (...) out that even where every audience member takes a video to be veridical, where first-order knowledge acquisition is secure, an audience aware of deepfakes in their environment will not acquire higher order knowledge in the way that has erstwhile been characteristic for audiences of VPAs. Engaging with ideas from the literatures on public announcement logic, common knowledge, and convention, I enumerate a variety of ways in which we should expect this absence of higher order knowledge to throw up barriers to political mobilization. I go on to apply my analysis of VPAs to the mechanisms by which an uptick in publicly available videos of police brutality over the last decade, mediated by camera phones and social media, was responsible for the largest mass protests in US history in summer 2020. This makes vivid the stakes of the transformation in our mobilizing environment that I've claimed deepfakes effect: where we lose the common-knowledge-generating effects of VPAs, there are fresh obstacles to this sort of mass mobilization. (shrink)

In this article, we provide an ethical analysis of the first porcine cardiac xenotransplant, performed in Maryland, USA in early 2022. David Bennett was offered the experimental procedure after he was deemed ineligible for human heart transplantation and mechanical circulatory support, based on a history of non-compliance. It was reported that Mr Bennett’s previous instances of non-compliance were for medically non-life-threatening conditions years earlier, where the risks of non-compliance were not as high. We argue that, in Mr Bennett’s case, a (...) history of non-compliance in a different context, should not necessarily rule him ineligible for a potentially life-saving treatment now. Furthermore, using previous non-compliance to exclude individuals from donor organs may have the unintended effect of placing the burden of testing xenotransplantation on those who are already disadvantaged. We then argue that it is not enough to rely on patient consent to ethically justify xenotransplantation research. Taking a broad ethical perspective is crucial when mapping a clinical pathway for xenotransplantation. (shrink)

This article systematically reviews studies investigating the effect of three operationalizations of complexity in emotion experience on situat...

Unrecognized conventions—practices that are conventional even though their participants do not recognize them as such—play central roles in shaping our lives. They range from the indispensable (e.g. unrecognized linguistic conventions) to the insidious (e.g. some of our gender conventions). Unrecognized conventions pose a challenge for accounts of conventions because it is difficult to incorporate the distinctive arbitrariness of conventions—the fact that conventions always have alternatives—without accidentally excluding many unrecognized conventions. I develop an Accessibility Requirement that allows us to account for (...) both arbitrariness and unrecognized conventions. Specifically, I argue that a conventional practice must have at least one alternative that is at least approximately as good and at least approximately as accessible as the conventional practice itself, independent of the dominance the practice gained as it became conventional. In the course of arguing for this requirement, I also show that two prominent accounts of conventions, David Lewis’s and Ruth Garrett Millikan’s, run into problems with capturing the arbitrariness of conventions. The Accessibility Requirement opens the door to improved accounts of conventions by precisely identifying the way in which conventions are arbitrary. (shrink)

In light of scientific advances such as genomics, predictive diagnostics, genetically engineered agriculture, nuclear transfer cloning, and the manipulation of stem cells, the idea that genes carry predetermined molecular programs or blueprints is pervasive. Yet new scientific discoveries—such as rna transcripts of single genes that can lead to the production of different compounds from the same pieces of dna—challenge the concept of the gene alone as the dominant factor in biological development. Increasingly aware of the tension between certain empirical results (...) and interpretations of those results based on the orthodox view of genetic determinism, a growing number of scientists urge a rethinking of what a gene is and how it works. In this collection, a group of internationally renowned scientists present some prominent alternative approaches to understanding the role of dna in the construction and function of biological organisms. Contributors discuss alternatives to the programmatic view of dna, including the developmental systems approach, methodical culturalism, the molecular process concept of the gene, the hermeneutic theory of description, and process structuralist biology. None of the approaches cast doubt on the notion that dna is tremendously important to biological life on earth; rather, contributors examine different ideas of how dna should be represented, evaluated, and explained. Just as ideas about genetic codes have reached far beyond the realm of science, the reconceptualizations of genetic theory in this volume have broad implications for ethics, philosophy, and the social sciences. Contributors. Thomas Bürglin, Brian C. Goodwin, James Griesemer, Paul Griffiths, Jesper Hoffmeyer, Evelyn Fox Keller, Gerd B. Müller, Eva M. Neumann-Held, Stuart A. Newman, Susan Oyama, Christoph Rehmann-Sutter, Sahotra Sarkar, Jackie Leach Scully, Gerry Webster, Ulrich Wolf. (shrink)

College students from small, medium, and large institutions with either a modified or no honor code were presented with cheating scenarios and asked to rate how dishonest they perceived the behavior to be and the likelihood that they would report it. No main effects were found for institution size or type of honor code. Student–faculty ratio was not correlated with responses to the cheating scenarios. Students from modified honor code schools perceived more severe punishments for cheating and understood the reporting (...) process better than students from non–honor code schools. Implications for modified honor code systems are discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When Is Enough, Enough?Megan HomsyThis was a case that stuck with many members of our transplant team for a long time. The patient was a 44-year-old Caucasian male evaluated for a liver transplant with a diagnosis of hepatitis C virus (HCV), originally diagnosed 11 years before the transplant evaluation. The patient met the criteria for the following substance use diagnoses: alcohol use disorder moderate in sustained remission, in (...) a controlled environment, opioid use disorder, severe, in sustained remission, on maintenance therapy, in a controlled environment, stimulant use disorder, amphetamine-type, severe, in early remission, in a controlled environment and stimulant use disorder, cocaine-type, severe in early remission, in a controlled environment.The patient had been living in a sober living housing program for approximately ten months prior to his transplant evaluation with me, his social worker. He had also been diagnosed with depression and bipolar disorder. He had been intermittently linked with mental health services and had participated in numerous detox and substance abuse programs over the last ten years, with varying degrees of success. He was in dual diagnosis treatment (i.e., treatment for co-occurring substance use and mental health disorders) through his Suboxone clinic and was completing toxicology screenings on a biweekly basis.After concluding the minimum three months of drug and alcohol treatment set forth by the state's Organ Transplantation Consortium, the patient graduated from his sober living program, moved in with his sister, and was listed for a liver transplant.The patient was transplanted five months after his clinic evaluation. At the time of the surgery, the patient's Suboxone was abruptly discontinued and replaced with IV Dilaudid. Within days of his transplant, the patient frequently expressed concerns about his pain. Several medical services attempted to manage the pain medications, resulting in his pain management plan being changed repeatedly and much confusion over his current medication regimen. During his liver transplant hospitalization, the RN found the patient with a needle in his arm, and after a search of the patient's hospital room, the hospital police found drug paraphernalia and illicit substances. The patient was eventually discharged to an inpatient substance abuse program, which he left before completing the program and against medical advice.During his first year post-transplant, I attempted to arrange other various treatment programs for him (most of which he did not follow through with) and to find housing for him (as he had been forced to leave his sister's home after his relapse). Eventually, the patient was incarcerated on drug-related charges. Numerous times, the patient missed completing his labs and his post-transplant appointments. He did not refill his immunosuppressant medications, and for lengthy periods of time, he was unreachable by the transplant care team, which resulted in my team members and I calling the patient's family, other providers, and the police for safety checks.In the aftermath of these issues, my colleagues and I had to reckon with the realization that we had failed the patient. As a team, our transplant center created a task force to review this case and what to do in the future to prevent such breakdowns in patient care. We created protocols for managing patients who, at the time of their transplant, are on Medication Assisted Treatment (MAT) such as Suboxone and methadone. Staff across the multidisciplinary team attended trainings regarding addiction, pain management, and best practices for MAT services. Additionally, our transplant center collaborated with our hospital's addiction treatment program for a streamlined referral process for transplant patients to addiction services.This patient's case and its sensational nature resulted in many conversations, both professional and unprofessional. Members of the social worker department became aware that personnel within transplant, though not involved in patient care, were inappropriately discussing this patient's case and engaging in unprofessional behavior. Said actions led to the termination of a member of the transplant team. I was placed in the unenviable [End Page E3] position of having to report this behavior to hospital management and legal teams to protect a vulnerable patient.The ethical challenge behind this case really stems from the transplant team attempting to balance two... (shrink)

Incapacitated adults with a legally appointed guardian or conservator may be recruited for or involved with medical, behavioral, or social science research. Much of the research in which such persons participate is aimed at evaluating medical interventions for them, or contributing to general knowledge about disorders from which they may suffer. In this paper we will consider how the appointment of guardians for patients with disorders of consciousness —severe brain injuries that affect a patient’s level of arousal and ability to (...) interact —impacts such patients’ access to research.Such persons may be under guardianship because they have lost decisional capacity (i.e., those in a coma or... (shrink)

En el siguiente artículo se recoge una singular mirada del lenguaje, desde una dimensión pragmática que sintetiza aportes relativos a la eficacia del lenguaje en la obra agustiniana. Desde un enfoque centrado en la responsabilidad y la autoapropiación de la acción lingüística, Agustín de Hipona se vierte a la detección de mecanismos volitivos y cognitivos que intervienen en los modos de uso e intercambio verbal para elaborar una singular y compleja reflexión sobre responsabilidad lingüística. Entre las relaciones y consecuencias más (...) visibles de cada acto de habla en específico, expone cómo en la enunciación se conjugan múltiples variables de raíces profundas, que no solo están conectadas con la dimensión del ethos, sino que contribuyen a su constitución y determinación cotidiana para una reflexión comunitaria. Por lo que el siguiente análisis ético-discursivo a los escritos del filósofo de Hipona conjugará estos aspectos y habilitará la apreciación de una noción de responsabilidad verbal basada en fundamentos de performatividad del lenguaje y sentido de transmisión en sus obras. (shrink)

Although scientific images have begun to receive significant attention from philosophers, one type of image has thus far been ignored: moving images. As techniques such as live cell imaging and videomicroscopy are becoming increasingly important in many areas of biology, however, this oversight needs to be corrected. Biologists often claim that there are relevant differences between video and static images. Most interesting is the idea that video images allow us to see causal relationships. By identifying the conditions that would be (...) required for this to be true and showing that they are not satisfied at the micro level, I will show that videomicroscopy does not provide us with special access to causal information. †To contact the author, please write to: Department of Philosophy, University of Calgary, 2500 University Dr. NW, Calgary, Alberta T2N 1N4; e-mail: [email protected]. (shrink)