Institutional review boards, tasked with facilitating ethical research, are often pulled in competing directions. In what we call the protection-inclusion dilemma, we acknowledge the tensions IRBs face in aiming to both protect potential research participants from harm and include under-represented populations in research. In this manuscript, we examine the history of protectionism that has dominated research ethics oversight in the United States, as well as two responses to such protectionism: inclusion initiatives and critiques of the term vulnerability. We look at (...) what we know about IRB decision-making in relation to protecting and including “vulnerable” groups in research and examine the lack of regulatory guidance related to this dilemma, which encourages protection over inclusion within IRB practice. Finally, we offer recommendations related to how IRBs might strike a better balance between inclusion and protection in research ethics oversight. (shrink)

It is argued here that the practice of medical students performing pelvic exams on women who are under anesthetic and have not consented is immoral and indefensible. This argument begins by laying out the ethical justification for the practice of informed consent, which can be found in autonomy and basic rights. Foregoing the process of consent within medicine can result in violations of both autonomy and basic rights, as well as trust, forming the basis of the wrong of unauthorized pelvic (...) examinations. Several objections to this argument are considered, all of which stem from the idea that this practice constitutes an exception to the general requirement of informed consent. These objections suggest that nonconsensual pelvic examinations on women under anesthetic are ethically acceptable on utilitarian grounds, in that they offer benefits either to the patient or to society, or on the grounds of triviality, in that consent is already presumed, or the practice is insignificant. Each of these objections is rejected and the practice is deemed indefensible. (shrink)

As participatory research practices are increasingly taken up in health research, claims related to experiential authority and expertise are frequently made. Here, in an exploration of what grounds such claims, we consider how feminist standpoint theory might apply to the psy sciences (psychiatry, psychology, psychotherapy, psychoanalysis, and so on). Standpoint theory claims that experiences of marginalization and critical engagement can lead to a standpoint that offers an epistemic advantage within a domain of knowledge. We examine experiences of marginalization and critical (...) engagement in the mental health system, as well as evidence for epistemic advantages resulting from these experiences. This evidence, found in the identification of problematic assumptions and the development of new tools and theories in the field, grounds our argument that standpoint theory is indeed relevant to the psy sciences and that many of those who have experienced marginalization and have engaged critically have an epistemic advantage when it comes to knowledge-production. The implications of this argument are significant: those who have attained a standpoint within the psy sciences ought to be included in research and given both tools and funding to develop research programs. However, we must be wary of the risks of tokenization, cooptation, and essentialization that are likely to accompany such a transformation. (shrink)

In their target article, Zamina Mithani, Jane Cooper, and J. Wesley Boyd make a compelling case for the importance of “counter storytelling” in bioethics. They obse...

This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the (...) debate to also include socially accepted behaviours or to provide an alternative explanation of the narrowly focused discussion. Second, a critical response is offered to arguments that claim that policies based on personal responsibility would lead to several positive outcomes including healthy behaviour change, better health outcomes and decreases in healthcare spending. It is argued that using individual responsibility as a basis for resource allocation in healthcare is unlikely to motivate positive behaviour changes, and is likely to increase inequality which may lead to worse health outcomes overall. Finally, the case of West Virginia's Medicaid reform is examined, which raises a worry that policies focused on personal responsibility have the potential to lead to increases in medical spending overall. (shrink)

Some thoughts on the nature of networks, the prevalence of emotional experiences, and the importance of new questions.

In recent years social financiers have been increasingly investing in alternative food systems to improve sustainability outcomes. However, social finance for alternative food systems remains small and marginalized. This article seeks to understand why this approach is not yet making a larger impact towards food system transformation. It does so by investigating a specific application of social finance through the case of Slow Money to get answers as to why social finance occupies a niche role in food system transformation. These (...) answers provide helpful lessons for Alternative Food Networks (AFNs) seeking to transform food systems towards greater sustainability. This study tracks the intended impacts of these initiatives and provides insights about the potential role of social finance for promoting AFNs. Key themes emerged regarding the ability of social financing initiatives to support AFNs and transform the food system for greater sustainability. These themes resonate with the literature on AFNs in meaningful ways, but also highlight an important contradiction between systemic change and individual action. The findings show that the Slow Money model contains some useful elements for radical transformation but is ultimately limited in its ability to support deeper, transformative change. The conclusion advances recommendations for ways of enhancing the transformative potential of community financing initiatives in light of the findings, emphasizing the role of public investments. (shrink)

I describe my current thinking on two old questions—the causal role of appraisals and the relationship of appraisal theories to basic emotions theories and constructivist theories, and three (sort of) new questions—the completeness of appraisals, the role of language, and the development of automaticity in emotional responses.

We investigate whether smile mimicry and emotional contagion are evident in non-text-based computer-mediated communication (CMC). Via an ostensibly real-time audio-visual CMC platform, participants interacted with a confederate who either smiled radiantly or displayed a neutral expression throughout the interaction. Automatic analyses of expressions displayed by participants indicated that smile mimicry was at play: A higher level of activation of the facial muscle that characterises genuine smiles was observed among participants who interacted with the smiling confederate than among participants who interacted (...) with the unexpressive confederate. However, there was no difference in the self-reported level of joviality between participants in the two conditions. Our findings demonstrate that people mimic smiles in audio-visual CMC, but that even though the diffusion of emotions has been documented in text-based CMC in previous studies, we find no convincing support for the phenomenon of emotional contagion in non-text-based CMC. (shrink)

This article reflects on the relevance and applicability of the Belmont Report nearly four decades after its original publication. In an exploration of criticisms that have been raised in response to the report and of significant changes that have occurred within the context of biomedical research, five primary themes arise. These themes include the increasingly vague boundary between research and practice, unique harms to communities that are not addressed by the principle of respect for persons, and how growing complexity and (...) commodification in research have shed light on the importance of transparency. The repercussions of Belmont's emphasis on the protection of vulnerable populations is also explored, as is the relationship between the report's ethical principles and their applications. It is concluded that while the Belmont Report was an impressive response to the ethical issues of its day, the field of research ethics involving human subjects may have outgrown it. (shrink)

Building on decades of rich discussions of why 'nothing about us without us' matters in the field of psychiatry, this paper aims to illuminate the justifications underlying participatory research in psychiatry, and how these justifications might shape participatory methodologies. This is accomplished through the examination of several epistemic and ethical features of psychiatry that underlie the importance of engaging in participatory research in the field, unpacking their connection to participatory research, and offering suggestions related to their implications for research methodologies. (...) The epistemic features include: the irreducible value of patient experience, the extent of disagreement and uncertainty in the field, and the value-laden nature of knowledge in psychiatry. The ethical features include: the preponderance of harm, denials of agency and epistemic injustice, and the constant struggle for power. These features offer useful touchpoints for thinking through why participation matters in mental health research. (shrink)

The practice of medically assisted dying has long been contentious, and the question of what to call it has become increasingly contentious as well. Particularly among U.S. proponents of legalizing the practice, there has been a growing push away from calling it “physician‐assisted suicide,” with assertions that medically assisted dying is fundamentally different from suicide. Digging deeper into this claim about difference leads to an examination of the difference between two kinds of suffering—suffering from physical conditions and suffering from psychological (...) conditions—and therefore leads also toward an examination of whether requests for medical assistance in dying by those suffering from psychological conditions and those suffering from physical conditions should be painted with the same brush. In this article, I aim both to illuminate some of the considerations that ought to be included in discussions related to medically assisted dying and to shed light on what the indirect effects of such discussions can be. I consider some of the reasons commonly given for holding that suicide and medically assisted dying differ fundamentally and then whether the conclusion that medically assisted dying should not be called “suicide” follows from the premises. I ask what else might justify the conclusion that the two acts ought to be called by different names, and I examine possible justifications for accepting this premise, as well as what justifications might exist for emphasizing how the acts are alike. Finally, I argue that we should be cautious before concluding that medically assisted dying should not be called “suicide.” We need more evidence either that the two acts are fundamentally different or that emphasizing differences between them is not likely to do more harm than good. (shrink)

Many are calling for concrete mechanisms of oversight for health research involving artificial intelligence (AI). In response, institutional review boards (IRBs) are being turned to as a familiar model of governance. Here, we examine the IRB model as a form of ethics oversight for health research that uses AI. We consider the model's origins, analyze the challenges IRBs are facing in the contexts of both industry and academia, and offer concrete recommendations for how these committees might be adapted in order (...) to provide an effective mechanism of oversight for health‐related AI research. (shrink)

During the COVID-19 pandemic, several hospitals implemented “birthing alone” policies, banning companions from accompanying individuals giving birth. We offer an ethical analysis of these policies. First, we examine them through a consequentialist framework of risks and benefits. Second, we consider the significance of birth, highlighting the unique ways in which risks, relationships, and rights are understood in the context of obstetrics. We conclude that birthing alone policies are largely unjustified, as the harm they are certain to cause outweighs their possible (...) benefits and because they fail to take into account what matters to mothers. (shrink)

In recent years, the possible benefits of mindfulness meditation have sparked much public and academic interest. Mindfulness emphasizes cultivating awareness of our immediate experience and has been associated with compassion, empathy, and various other prosocial traits. However, neurobiological evidence pertaining to the prosocial benefits of mindfulness in social settings is sparse. In this study, we investigate neural correlates of trait mindful awareness during naturalistic dyadic interactions, using both intra-brain and inter-brain measures. We used the Muse headset, a portable electroencephalogram device (...) often used to support mindfulness meditation, to record brain activity from dyads as they engaged in naturalistic face-to-face interactions in a museum setting. While we did not replicate prior laboratory-based findings linking trait mindfulness to individual brain responses, self-reported mindful awareness did predict dyadic inter-brain synchrony, in theta and beta frequencies. These findings underscore the importance of conducting social neuroscience research in ecological settings to enrich our understanding of how neural correlates of social traits such as mindful awareness manifest during social interaction, while raising critical practical considerations regarding the viability of commercially available EEG systems. (shrink)

Suetonius’Lives of the Caesarscontain at least twenty discrete anecdotes about childhood (pueritia) and youth (iuuentaoradulescentia) spread across theLives. Some characterize the Caesars by looking forwards (foreshadowing) and others do so by looking backwards (flashbacks). In both foreshadowing and flashback, the childhood anecdote shows continuity with the adult and creates the impression of lifelong consistency of character. The foreshadowing technique is also something other ancient biographers do; the flashback is something that appears to be unique to Suetonius. In this note I (...) briefly consider the stories from childhood and youth that foreshadow character traits and themes of the rest of theLife, and then the flashbacks from the adulthood section of theLifethat refer to childhood and youth in order to demonstrate vices of the grown adult. I show that the use of foreshadowing and flashbacks contributes to the appearance of a fully formed character in the child that will be consistent into adulthood, as well as facilitating the rubric system of arranging material by type rather than by time. (shrink)

Sensory and tracking technologies are being introduced into workplaces in ways Taylor and the Gilbreths could only have imagined. New work design experiments merge wellness with productivity to measure and modulate the affective and emotional labour of resilience that is necessary to survive the turbulence of the widespread incorporation of agile management systems, in which workers are expected to take symbolic direction from machines. The Quantified Workplace project was carried out by one company that fitted sensory algorithmic devices to workers’ (...) computers and bodies, which, this article argues, identify workers’ so-called agility and reveal management practices that track affective and emotional labour, categorized in the project as stress, subjective productivity and wellbeing. Capital’s accelerated attempts to capture more areas of work and workers’ capacities facilitate the conversion of labour power into a source of value but also results in alienation and abstraction. Participants’ resistance to participation in the Quantified Workplace reveals tensions in the labour process when affect is measured in processes of corporate change. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 28-31, January/February 2022.

This paper offers a critical analysis of several accounts of the placebo effect that have been put forward. While the placebo effect is most often thought of as a control in research and as a deceptive tool in practice, a growing body of research suggests that it ought to be thought of as a powerful phenomenon in its own right. Several accounts that aim to draw boundaries around the placebo effect are evaluated in relation to current evidence and it is (...) argued that none of them adequately capture the variability and potency of the phenomenon. Two accounts, however, that point towards the underlying mechanisms of the placebo effect, are shown to offer promise in terms of developing a more comprehensive account of the placebo effect. (shrink)

In the introduction to a recent anthology of contemporary issues in philosophy of psychiatry, editors Jeffrey Poland and Şerife Tekin declare this to be a moment of crisis within the field. They suggest that the state of psychiatry today reflects Thomas Kuhn's conception of a period of extraordinary science, which occurs when anomalies begin to build up, confidence in the dominant paradigm is shook, competing theories arise, and philosophical questions come to the fore. Although perhaps not all would agree that (...) the field is in crisis, there is certainly an abundance of pessimism. Within the realm of research, a mood of explanatory pessimism has been growing, characterized by a... (shrink)

This article provides a brief introduction to psychological emotion theories, particularly appraisal theory. According to appraisal theory emotions are combinations of a person’s appraisal of the novelty, valence, certainty, goal conduciveness, causal agency, controllability, and morality of a situation. These dimensions correspond to elements of the stories attorneys attempt to create in arguing a case. Appraisal theory puts specific content into the vague concept of reappraisal, accounting for emotional changes that go beyond the changes in valence and intensity generally studied (...) by law and emotions scholars. (shrink)

Racial disparities in pain treatment are well documented. Such disparities are explained with reference to factors related to providers, health care structures, and patient behaviors. Racial differences in pain experiences, although well documented, are less well understood. Explanations for such differences usually involve genetic or psychological factors. Here, we argue that racial differences in pain experiences might also be explained by disparities in pain treatment. Based on what we know about the nature of pain, particularly the cognitive and affective aspects (...) of the phenomenon, it is likely that disparities in the treatment of racialized patients can lead to significant racial differences in pain experience that show up at the population level. We argue that the failure of research programs to consider this causal factor is an example of white ignorance. We also consider several implications of the link between racial disparities in pain treatment and racial differences in pain experience. (shrink)

The ‘new normality’ of food crises requires nuanced understandings of emergent responses. Through an exploratory analysis of public-facing reports from major food governance actors, this study empirically outlines mainstream solution frames for addressing the contemporary food crisis and the ways in which these differ from the 2008 food crisis. Using food regime theory as the theoretical underpinning, four con­sistently used solution frames are identified that provide insight into the organizing principles of the third food regime: promoting trade liberalization, emphasizing agricultural (...) productivism, mobilizing private finance, and leveraging data. The latter two involve recent shifts in governance responses that shape global food governance and impact global food insecurity in novel ways. (shrink)

This paper argues that management practices are more readily portable across the sectors than has often been supposed, while indicating where particular care will be needed in translation. The paper suggests, however, that political pressure for control and an epistemological bias may prove to be management's Achilles heel. Further, it examines some dilemmas in the relationship between the manager and the managed, and queries the professions' outrage at being subject to increasingly overt management.

A recurring problem in psychiatry is the meaningfulness, or otherwise, of its domain. Critics of psychiatry accuse the discipline of misconstruing mental phenomena and behavior, including the verbal sort, as meaningless symptoms, in keeping with other medical specialisms. A myoclonic jerk is taken by the neurologist to mean nothing beyond signaling pathology of the nervous system. But this approach, critics argue, strips psychiatric phenomena of their meaning. Accordingly, Louis Sass has described a tendency, "particularly among organic psychiatrists… to ignore the (...) psychological interpretation or empathic understanding of mental symptoms". Neuropsychiatric symptoms such as visual hallucinations... (shrink)

While a significant body of bioethical literature considers how the placebo effect might introduce a conflict between autonomy and beneficence, the link between justice and the placebo effect has been neglected. Here, we bring together disparate evidence from the field of placebo studies and research on health inequalities related to race and ethnicity, and argue that, collectively, this evidence may provide the basis for an unacknowledged route by which health disparities are exacerbated. This route is constituted by an uneven distribution (...) of placebo effects, resulting from differences in expressions of physician warmth and empathy, as well as support and patient engagement, across racial and ethnic lines. In a discussion of the ethical implications of this connection, we argue that this contribution to health disparities is a source of injustice, consider ways in which these disparities might be ameliorated and suggest that this conclusion is likely to extend to other realms of inequality as well. (shrink)

The jury remains out about the bottom-line relevance of organisational spirituality. This article reviews the arguments made thus far, using those sources most commonly cited as providing ‹evidence’ that organisational spirituality adds value to the bottom line. Having collated the evidence, this article offers some observation about the robustness of this existing ‹business case’. It then offers some preliminary conclusions on the literature review, examining the merits of pursuing a ‹business case’ in this field and identifying some specific questions for (...) future research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Democratizing Psychiatric ResearchRecognizing the Potential and the Limits of Experiential ExpertiseThe author reports no conflict of interests.First, I want to express my gratitude for such thoughtful and generative responses to the manuscript "Why Democratize Psychiatric Research?," which has been in development for several years and is the product of much reflection that has taken place in academic, advocacy, and interpersonal contexts. I am delighted to see such insightful engagement (...) with the piece and to have a chance to respond to both Drs. David Crepaz-Keay and Sam Fellowes here. Given that the authors raise such different questions within their commentaries, I consider each in turn.In his illuminating commentary, Crepaz-Keay makes three important points in response to the epistemic and ethical reasons I lay out as justifications for democratizing efforts in mental health research. First of all, Crepaz-Keay warns that there is "more subjectivity across much of medicine" than in the picture I've painted, and that we might do better to focus on this shared territory, taking up the goal of democratization across all of medicine, rather than risk "othering" psychiatry as uniquely subjective. In this way, Crepaz-Keay emphasizes, mental health service user researchers might "become leaders in progressive medical thinking."I appreciate this call to emphasize the ways in which the importance of subjective experiences cuts across all of medicine and to learn broad lessons from the pioneering participatory work that has been accomplished in the domain of mental health. I agree that much of medicine suffers from a focus on the objective to the neglect of the subjective, and wonder if this focus can sometimes create a distinct kind of worry in territories in which objective measures are widely available. Consider the focus on reducing the size of a tumor at all costs that can sometimes obscure important considerations related to what a good end of life might look like (Gawande, 2014). Particularly [End Page 143] within the process of determining what is worth measuring within research (and what is worth treating within clinical contexts), patient voices are essential to making an informed and beneficial decision. I agree with Crepaz-Keay here—this point applies to all realms of medicine.In contrast, I think other kinds of risks arise in domains in which objective measures are not widely available and therefore subjective reports of patients make up an essential part of any diagnosis or assessment. Another area I often think about is placebo studies, and in this space, stereotypes related to 'real' suffering and 'real' healing circulate widely (Friesen, 2019b). Largely, these stereotypes tend to support the importance and reality of that which occurs at the level of the physical or biological and take much less seriously suffering or healing which is thought to be located 'all in the head' (Friesen & Dionne, 2022). These biases also cut across medicine, influencing which patients are seen as trustworthy, dramatic, or worthy of one's compassion. I would argue that they show up especially in the setting of mental health care and research, in part because of the lack of objective measures and physiological explanations. A psychiatrized patient often has nothing physical or objective to point to with regard to their suffering, and so may be at the whim of a provider in relation to whether they are likely to be believed or discredited. As such, we must be especially alert to the unique risks that arise when evidence for suffering comes in a subjective form, and how efforts toward democratization might help reduce such risks.Second, Crepaz-Keay offers an essential intervention in relation to the importance of anti-racism within participatory practices in psychiatry. Although I do make mention of the lack of representation of racialized communities in participatory psychiatric research in discussing the important role that values play in the development of psychiatric knowledge, Crepaz-Keay accurately points out that this point related to representation is cross-cutting, and highly relevant to several of the other reasons I offer for why psychiatry research ought to be democratized. I am grateful for this invitation to look more broadly at how the exclusion of some voices from participatory efforts might apply across... (shrink)

This article describes James’s distaste for taxonomic classification of emotion and argues that he would not have been pleased by current scholarship which still focuses on the definition and classification of discrete emotions, distracting scholars from more fundamental underlying processes. I argue that as in James’s time, current taxonomies are still arbitrary and still constrain the kinds of questions psychologists ask.

The second annual Alchemy Lecture was presented in November 2023 at York University to a sold out in-person audience and nearly one thousand live online viewers. Moderated by Christina Sharpe, the Alchemists-agile thinkers and practitioners working across a range of disciplines and geographies-convened to discuss their radical visions of the beautiful world, and the manifestos that may help to guide us there. Their treatises have been captured and luminously expanded in the pages of this book. Cherokee Nation citizen and professor (...) Joseph M. Pierce asserts that "[f]or this decolonial future to become possible, the guiding force must no longer be capital but relations." Informed by her practice of "curation as care," Brazilian film curator Janaína Oliveira evokes music and movement as a means toward this relationality: "it's almost by falling that you live.... The beautiful world dances the stumbles. The beautiful world dances dancing." Kenyan-British visual artist Phoebe Boswell uses the space of a virtual gallery to ask, "If we burn down the institution, what happens next? Do we trust ourselves to know?" and gestures toward the possibility of this "as yet unlived, unexperienced thing." Professor and MacArthur fellow Saidiya Hartman asks us to consider our capacity to burn, stating that "[P]ragmatism yields a profound tolerance of the unlivable." And Mexican-American author Cristina Rivera Garza gives us the language of the future in the subjunctive, which "lays the groundwork for the irruption.... The subjunctive is the smuggler who crosses the border of the future bearing unknown cargo." Through these expansive, transformative essays, new ways of being are threaded and proposed, illuminating our path towards this possible beautiful world. (shrink)