Volume 25, Issue 2, February 2025, Page 140-142.

Ethical questions arise in clinical spaces most often as the result of competing ethical principles, not because someone is acting unethically. Ethics consultants engage with care teams, patients,...

The pandemic creates unprecedented challenges to society and to health care systems around the world. Like all crises, these provide a unique opportunity to rethink the fundamental limiting assumptions and institutional inertia of our established systems. These inertial assumptions have obscured deeply rooted problems in health care and deflected attempts to address them. As hospitals begin to welcome all patients back, they should resist the temptation to go back to business as usual. Instead, they should retain the more (...) deliberative, explicit, and transparent ways of thinking that have informed the development of crisis standards of care. The key lesson to be learned from those exercises in rational deliberation is that justice must be the ethical foundation of all standards of care. Justice demands that hospitals take a safety‐net approach to providing services that prioritizes the most vulnerable segments of society, continue to expand telemedicine in ways that improve access without exacerbating disparities, invest in community‐based care, and fully staff hospitals and clinics on nights and weekends. (shrink)

Large-scale sequencing tests, including whole-exome and whole-genome sequencing, are rapidly moving into clinical use. Sequencing is already being used clinically to identify therapeutic opportunities for cancer patients who have run out of conventional treatment options, to help diagnose children with puzzling neurodevelopmental conditions, and to clarify appropriate drug choices and dosing in individuals. To evaluate and support clinical applications of these technologies, the National Human Genome Research Institute and National Cancer Institute have funded studies on clinical and research sequencing under (...) the Clinical Sequencing Exploratory Research program as well as studies on return of results. Most of these studies use sequencing in real-world clinical settings and collect data on both the application of sequencing and the impact of receiving genomic findings on study participants. They are occurring in the context of controversy over how to obtain consent for exome and genome sequencing. (shrink)

Background: Genomic analysis may reveal both primary and secondary findings with direct relevance to the health of probands’ biological relatives. Researchers question their obligations to return findings not only to participants but also to family members. Given the social value of privacy protection, should researchers offer a proband’s results to family members, including after the proband’s death? Methods: Preferences were elicited using interviews and a survey. Respondents included probands from two pancreatic cancer research resources, plus biological and nonbiological family (...) members. Hypothetical scenarios based on actual research findings from the two cancer research resources were presented; participants were asked return of results preferences and justifications. Interview transcripts were coded and analyzed; survey data were analyzed descriptively. Results: Fifty-one individuals (17 probands, 21 biological relatives, 13 spouses/partners) were interviewed. Subsequently, a mailed survey was returned by 464 probands, 1,040 biological family members, and 399 spouses/partners. This analysis highlights the interviews, augmented by survey findings. Probands and family members attribute great predictive power and lifesaving potential to genomic information. A majority hold that a proband’s genomic results relevant to family members’ health ought to be offered. While informants endorse each individual’s choice whether to learn results, most express a strong moral responsibility to know and to share, particularly with the younger generation. Most have few concerns about sharing genetic information within the family; rather, their concerns focus on the health consequences of not sharing. Conclusions: Although additional studies in diverse populations are needed, policies governing return of genomic results should consider how families understand genomic data, how they value confidentiality within the family, and whether they endorse an ethics of sharing. A focus on respect for individual privacy—without attention to how the broad social and cultural context shapes preferences within families—cannot be the sole foundation of policy. (shrink)

In three studies, we explored the retention and transfer of tool-making knowledge, learnt from an adult demonstration, to other temporal and task contexts. All studies used a variation of a task in which children had to make a hook tool to retrieve a bucket from a tall transparent tube. Children who failed to innovate the hook tool independently saw a demonstration. In Study 1, we tested children aged 4 to 6 years (N = 53) who had seen the original demonstration (...) 3 months earlier. Performance was excellent at the second time, indicating that children’s knowledge was retained over the 3 month period. In Studies 2 and 3 we explored transfer of the new knowledge to other tasks. In Study 2, children were given two variants of the apparatus that differed in surface characteristics (e.g. shape and colour). Participants generalised their knowledge to these new apparatuses even though the new pipecleaner also differed in size and colour. Five- to 6-year-olds (n = 22) almost always transferred their knowledge to problems where the same tool had to be made. Younger, 3- to 5-year-olds’ (n = 46), performance was more variable. In Study 3, 4- to 7-year-olds (N = 146) saw a demonstration of hook making with a pipecleaner, but then had to make a tool by combining pieces of wooden dowel (or vice versa: original training on dowel, transfer to pipecleaner). Children did not transfer their tool-making knowledge to the new material. Children retained tool-making knowledge over time and transferred their knowledge to new situations in which they needed to make a similar tool from similar materials, but not different materials. We concluded that children’s ability to use tool-making knowledge in novel situations is likely to depend on memory and analogical reasoning, with the latter continuing to develop during middle childhood. (shrink)

In this paper, we argue that in order for the study of arts education to continue to advance, we must delineate the effects of particular forms of arts education, offered in certain contexts, on specific domains of children’s socioemotional development. We explain why formulating precise hypotheses about the effects of arts education on children’s socioemotional development requires a differentiated definition of each arts education program or activity in question, as well as a consideration of both the immediate and broader contexts (...) in which that program or activity occurs. We then offer the New Victory Theater’s Schools with Performing Arts Reach Kids program as an illustrative example of how these considerations allow for the refinement of hypotheses about the impact of arts education on children’s socioemotional development. (shrink)

In 2018, at least 12 adults and 3 children died in U.S. detention facilities. In 2017, 12 people died in U.S. detention facilities and at least 10 women filed complaints against ICE for mistreatment that led them to miscarry. At the time of this writing, 26 people have died in US Custody during the Trump Administration and 74 people have died in U.S. detention facilities between 2010 and 2018, including Raul Ernesto Morales-Ramos, Augustina Ramirez-Arreola, Moises Tino-Lopez, Jose Azurdia, and Roxana (...) Hernandez. I am not going to argue that these deaths are wrong – I take that as obvious. Instead, I will suggest that nonideal theory shows why bioethicists have special obligations for condemning these deaths and getting involved to make them stop. When we heed nonideal theory’s demand to consider empirical realities, we will see that the role of the bioethicist extends wherever health care does. Moreover, when bioethicists expressly embrace nonideal rather than ideal theories to ground our work, we will see that there are plenty such theories available to us. Shelly Wilcox’s nonideal theory of immigration justice is especially well suited for bioethicists to use in relation to detainee health care and enter the conversation where they are so desperately needed. (shrink)

Summary Ian Hunter's early work on the history of literature education and the emergence of English as school subject issued a bold challenge to traditional accounts that have in the main focused on English either as knowledge of a particular field or as ideology. The alternative proposal put forward by Hunter and supported by detailed historical analysis is that English exists as a series of historically contingent techniques and practices for shaping the self-managing capacities of children. The challenge for the (...) field is to advance this historical work and to examine possible implications for English teaching. (shrink)

Health research has shown that overweight and obesity in children and adults are becoming significant public health problems in the developing world. Evidence suggests that this phenomenon is more marked in urban than rural areas and may be associated with modernization. However, the underlying reasons for this nutrition transition remain unclear. Dietary shifts, often in conjunction with income and time constraints in urban environments, may entail a greater reliance on more convenient sugar and fat-dense food. Also, the necessity (...) of labor-intensive agricultural work to meet rural subsistence needs is supplanted in urban environments by sedentary work. This paper extends the application of human behavioral ecology theory into the realm of international development and policy by applying Kaplan’s embodied capital theory to explore differences in food habits and nutritional status of Indo-Fijian children within the context of urbanization. Urban high-embodied-capital women demonstrate higher rates of wage-earning employment than urban low-embodied-capital or rural women. Findings indicate that urban high-embodied-capital households spend significantly more on food purchases, purchase a greater proportion of processed foods, and have children with higher body mass indexes (BMI) than do urban low-embodied-capital or rural households. This suggests that urban high-embodied-capital mothers, who tend to be employed, may be making trade-offs between income and food choices. (shrink)

The authors are members of the British Association Committee on Social Concern and Biological Advances. Following earlier discussions of legal and social problems arising from certain medical advances, they undertook, independently, to examine the Law Commission's study.

This article reviews recent developments in health care law, focusing on the engagement of law as a partner in health care innovation. The article addresses: the history and contents of recent United States federal law restricting the use of genetic information by insurers and employers; the recent federal policy recommending routine HIV testing; the recent revision of federal policy regarding the funding of human embryonic stem cell research; the history, current status, and need for future attention to advance (...) directives; the recent emergence of medical–legal partnerships and their benefits for patients; the obesity epidemic and its implications for the child’s right to health under international conventions. (shrink)

BackgroundExposure to early life stress is alarmingly prevalent and has been linked to the high rates of depression documented in adolescence. Researchers have theorized that ELS may increase adolescents’ vulnerability or reactivity to the effects of subsequent stressors, placing them at higher risk for developing symptoms of depression.MethodsWe tested this formulation in a longitudinal study by assessing levels of stress and depression during the COVID-19 pandemic in a sample of adolescents from the San Francisco Bay Area who had been characterized (...) 3–7 years earlier with respect to exposure to ELS and symptoms of depression.ResultsAs expected, severity of ELS predicted levels of depressive symptoms during the pandemic [r = 0.26, p = 0.006], which were higher in females than in males [t = −3.56, p < 0.001]. Importantly, the association between ELS and depression was mediated by adolescents’ reported levels of stress, even after controlling for demographic variables.ConclusionsThese findings underscore the importance of monitoring the mental health of vulnerable children and adolescents during this pandemic and targeting perceived stress in high-risk youth. (shrink)

There is nothing more humbling to one’s inner moral compass than to realize that you do not initially know what is right or wrong! I found myself in just such a situation after reading the above case. Much has been written, both in the professional literature and the popular media, about the “Ashley Treatment” since Gunther and Diekema published their article in 2006. It is unclear if others in the United States or around the world have, to any significant degree, (...) adopted growth attenuation therapy and/or surgical intervention for children with severe neurological compromise, but the case quoted above suggests that hospital ethics committees may also be struggling with these decisions. An informal survey of pediatric endocrinologists, mentioned in a recent article on the topic, claims that many physicians are facing this dilemma as well. (shrink)

Background Central to the involvement of children in health research is the notion of risk. In this paper we present one of the factors, a matter of trust, that shaped Canadian parents' and children's perceptions and assessments of risk in child health research. Participants and methods Part of a larger qualitative research study, 82 parents took part an in-depth qualitative interview, with 51 parents having children who had participated in health research and 31 having children with no (...) research history. 51 children ranging from 6 to 19 years of age were also interviewed, with 28 having a history of participation in child health research and 23 having no history. Children also took part in 3 focus groups interviews. Themes emerged through a grounded theory analysis of coded interview transcripts. Findings The presence or absence of trust was not only perceived by parents and children as a contributing factor to involving children in health research, but also shaped their perceptions and assessments of risk. Three interrelated subthemes identified were: (1) relationships of trust; (2) placing trust in symbols of authority; and (3) the continuum of trust. Conclusions Our study reinforces that trust is an important factor when parents assess risk in child health research and shows that children use the language of trust in relation to risk. More discussion regarding trust in training researchers is warranted given the trust in researchers and institutions evident in this study. We also recommend further study of the continuum of trust in child health research. (shrink)

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

_Philosophy and Animal Life_ offers a new way of thinking about animal rights, our obligation to animals, and the nature of philosophy itself. Cora Diamond begins with "The Difficulty of Reality and the Difficulty of Philosophy," in which she accuses analytical philosophy of evading, or deflecting, the responsibility of human beings toward nonhuman animals. Diamond then explores the animal question as it is bound up with the more general problem of philosophical skepticism. Focusing specifically on J. M. Coetzee's _The Lives (...) of Animals_, she considers the failure of language to capture the vulnerability of humans and animals. Stanley Cavell responds to Diamond's argument with his own close reading of Coetzee's work, connecting the human-animal relation to further themes of morality and philosophy. John McDowell follows with a critique of both Diamond and Cavell, and Ian Hacking explains why Cora Diamond's essay is so deeply perturbing and, paradoxically for a philosopher, he favors poetry over philosophy as a way of overcoming some of her difficulties. Cary Wolfe's introduction situates these arguments within the broader context of contemporary continental philosophy and theory, particularly Jacques Derrida's work on deconstruction and the question of the animal. _Philosophy and Animal Life_ is a crucial collection for those interested in animal rights, ethics, and the development of philosophical inquiry. It also offers a unique exploration of the role of ethics in Coetzee's fiction. (shrink)

When someone encounters an explanation perceived as weak, this may lead to a feeling of deprivation or tension that can be resolved by engaging in additional learning. This study examined to what extent children respond to weak explanations by seeking additional learning opportunities. Seven‐ to ten‐year‐olds (N = 81) explored questions and explanations (circular or mechanistic) about 12 animals using a novel Android tablet application. After rating the quality of an initial explanation, children could request and receive additional information or (...) return to the main menu to choose a new animal to explore. Consistent with past research, there were both developmental and IQ‐related differences in how children evaluated explanation quality. But across development, children were more likely to request additional information in response to circular explanations than mechanistic explanations. Importantly, children were also more likely to request additional information in direct response to explanations that they themselves had assigned low ratings, regardless of explanation type. In addition, there was significant variability in both children's explanation evaluation and their exploration, suggesting important directions for future research. The findings support the deprivation theory of curiosity and offer implications for education. (shrink)

Democracy and justice are often mutually antagonistic ideas, but in this innovative book Ian Shapiro shows how and why they should be pursued together. Justice must be sought democratically if it is to garner legitimacy in the modern world, he claims, and democracy must be justice-promoting if it is to sustain allegiance over time. _Democratic Justice_ meets these criteria, offering an attractive vision of a practical path to a better future. Wherever power is exercised in human affairs, Shapiro argues, the (...) lack of democracy will be experienced as injustice. The challenge is to democratize social relations so as to diminish injustice, but to do this in ways that are compatible with people’s values and goals. Shapiro shows how this can be done in different phases of the human life cycle, from childhood through the adult worlds of work and domestic life, retirement, old age, and approaching death. He spells out the implications for pressing debates about authority over children, the law of marriage and divorce, population control, governing the firm, basic income guarantees, health insurance, retirement policies, and decisions made by and for the infirm elderly. This refreshing encounter between political philosophy and practical politics will interest all those who aspire to bequeath a more just world to our children than the one we have inherited. (shrink)

The surprise announcement in November 2018 that a Chinese researcher had implanted and brought to term two gene-edited embryos, resulting in the birth of twin girls, had the effect of galvanizing a debate that goes back decades. Should we make heritable changes in our children's DNA? Until recently, this was hypothetical only, and the easy response was to say it is too uncertain and too unnecessary to be tolerated. Suddenly, however, the possibility that there might be real uses for mitochondrial (...) DNA replacement or for germline editing has led to a more nuanced debate, ranging from calls to double-down on prohibiting this technology to discussions of how to permit it for a... (shrink)

The coronavirus (COVID-19) pandemic has challenged the dental health profession in an unprecedented manner. Suspension of elective dental care across the United States during the initial phase of the pandemic was necessary to prevent viral transmission. The emergency dental care that was provided had to be tailored to minimize the generation of aerosols. With the suspension of elective care, over time, the proportion of dental emergencies was anticipated to rise. Dentists who care for children have continued to provide emergency (...) dental treatment to this vulnerable population. Treatment decisions for pediatric dental emergencies had to be tailored to principles of public health that best mitigated risk of viral transmission. Decisions needed to balance the benefits of chosen treatment modality for the individual child with the risk of viral transmission to dental professionals and their staff, patients, and community. The paucity of reliable research for dentists to aid in clinical decision making may have left careproviders feeling ethically and morally insecure in shifting from a patient-centered to a community-centered paradigm. We present analysis of four pediatric emergency case scenarios that are representative of those likely to present to a private practice, academic setting, or emergency department during the pandemic. This analysis aims to empower dentists who care for children to implement the American Dental Association’s Principles of Ethics & Code of Professional Conduct within the context of a global health crisis. (shrink)

The report by Barbara Bierer and Mark Barnes highlights the complexities experienced by institutions that conduct Public Health Service‐funded research involving human subjects and that need to negotiate the requirements of two sets of federal regulations: 45 C.F.R. 46, covering protections for human research subjects, and 42 C.F.R. 93, the PHS policies on research misconduct. As the nation's single largest sponsor of biomedical and behavioral research, the National Institutes of Health seeks to exemplify and promote human research protections (...) and the highest level of scientific integrity, public accountability, and social responsibility in the conduct of science. The NIH is committed to protecting the rights and welfare of research participants and to upholding integrity standards for research supported with public funds. However, human subjects protections must always take priority. (shrink)

Social norm transgressions are assumed to be at the root of numerous substantial negative outcomes for transgressors. There is a prevailing notion among lay people and scholars that transgressing social norms can negatively impact one’s mental health. The present research aimed to examine this assumption, focusing on clinically relevant outcomes such as anxiety and depression. The present research further aimed to examine a social cognitive process for these outcomes in the form of fear of negative evaluations as a result (...) of one’s norm transgressing behavior. Specifically, it examined whether it is negative evaluations about ourselves or about those close to us that mediates the effect of social norm transgressions, and whether those may vary as a function of culture. Results of the present research, including a study with a community sample, suggest a positive association between social norm transgressions and psychological distress. Results also suggest that increased fear of negative evaluation mediates that association but does so differently for people from more collectivistic cultures and people from less collectivistic cultures. For people from more collectivistic cultures increased fear of negative evaluation of close others may mediate the association between social norm transgressions and psychological distress. However, for people from less collectivistic cultures that association may be mediated by increased fear of negative evaluation of oneself. Implications for research on consequences of social norm transgressions and cross-cultural differences in perceptions of such consequences are discussed as are practical implications for motivating social norm adherence and the maintenance of constructive social norms. (shrink)

> Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference 26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of (...) nature and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions. Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory. The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4 Global heating is also contributing to the decline in …. (shrink)

Nurse Ethicists bring a unique perspective to clinical ethics consultation. This perspective provides an appreciation of ethical tensions that will exist beyond the consult question into the moral space of patient care. These tensions exist even when an ethically preferable plan of action is identified. Ethically appropriate courses of action can still lead to moral dilemmas for others. The nurse ethicist provides a lens well suited to identify and respond to these dilemmas. The nurse–patient relationship is the ethical foundation of (...) nursing practice and this relational ontology is well suited to addressing ethical dilemmas that exist prior to and beyond the initial consult question. This paper will describe one nurse ethicist’s phronetic and pragmatic approach to a clinical ethics consult elucidated through feminist ethics and systems thinking. This paper will describe the theoretical basis for this method, present a case, and describe how this consultation approach provides a rich analysis based around relationships and responsibilities that also highlights the important ethical tensions within the social structure that exists around the patient and continue after the consult question is answered. (shrink)

In recent years, shared decision-making has become entrenched in the medical literature and the law as the ideal method for involving patients in decisions related to their health care. Shared decision-making represents a compromise between the opposed extremes of paternalistic interactions that limit patients’ control of their health care, and “informed choice” interactions that require physicians to provide technical expertise only, leaving patients to make all treatment decisions on their own. An implicit goal of shared decision-making is to (...) improve medical care by promoting joint participation of patients and physicians in clinical consultations. The model of shared decision-making may, however, inadequately address the health care needs of lower literate patients, a significant portion of the general population.As shared decision-making is widely held as a clinical ideal, we highlight the difficulties that physicians might have in implementing shared decision-making with lower literate patients. (shrink)

BackgroundObtaining consent has become a standard way of respecting the patient’s rights and autonomy in clinical research. Ethical guidelines recommend that the child’s parent/s or authorised legal guardian provides informed consent for their child’s participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child’s illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy (...) will assist in developing appropriate consent guidelines.MethodsWe conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants’ views about informed consent processes. Data analysis was facilitated by NVIVO 11 software.ResultsAll participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting.ConclusionThe health care context, culture and research process influenced participants’ understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent.Trial registration Not applicable. (shrink)

There are many lessons that bioethics can learn from the Holocaust. Forefront are the lessons from the Nuremberg trials and the formation of research ethics. An often-overlooked lesson is how the Nazi regime was able to construct a hierarchy in such a way that influenced people to act in horrendous ways. Fernandes & Ecret, writing in Conatus – Journal of Philosophy 4, no. 2, highlight the influence of hierarchy on the moral silence of nurses and physicians within the Nazi regime. (...) While we greatly enjoyed the paper, and think it is an important contribution, we find several misrepresentations of current bioethical discourse. There is not a global acceptance of euthanasia or medical aid in dying, the contemporary position in bioethics does not favor removal of conscience-based protections, and the lack of personal conscience-based protections was not the main factor in the analysis of Nazi medical hierarchy. The authors’ overall conclusion that their analysis suggests the importance of strengthening personal conscience-based objections to prevent medical hierarchy from influencing immoral behavior misses the more significant issue of institutional behavior. Instead, we argue, that the lessons from the analysis of Nazi nurses and physicians speak to the importance of protecting patients from institutional conscience-based objections that violate patient rights of access to legal medical services. This paper will respond to the misrepresentations. We highlight the growing threats to health care access from religious affiliated institutions, the threats to professional ethics and physician and nurse scope of practice. We conclude that the analysis by Fernandes & Ecret does point out an important lesson, but rather than showing the importance of individual conscience protections, it speaks to the importance of protecting patient rights. (shrink)

The neonatologist was describing the dire situation, the complexity of the fetus's anomalies, and the options—comfort care, some resuscitation—and finished by saying, “We would not recommend ECMO …” “We would not recommend” is a curious phrase. There is something ambiguous, very nebulous about it, something passive, noncommittal, maybe even deflective. As a bioethics researcher, I wondered how this phrase is interpreted, how it influences parents' moral deliberation over their options.

Matthew Lipman’s Thinking in Education develops an approach to philosophical inquiry with children (PwC) that claims to develop critical, creative and caring thinking. With Lipman, these kinds of thinking are primarily tied to analytic-logical commitments, and as such, his approach concerns only one way to conceptualize thinking. To address this issue and create space for another understanding, I introduce the concept of affect based on the work of the French philosopher Gilles Deleuze. From a theoretical perspective, affect helps to deepen (...) the relationship between thinking, the body and experience in PwC; in addition, from a practical standpoint, it expands and enriches facilitation practices and curriculum design. To explore affect, I first show why PwC would benefit from such a theoretical expansion while also looking at connections already present within the literature on PwC. After a brief overview of affect theory and some of its initial applications to education, I propose a reading of Deleuzian affect augmented by thinkers like Claire Colebrook and Brian Massumi. Finally, I explore philosophical inquiry through affect and suggest how facilitation practices and curriculum design can respond in lieu of this conceptualization. This response examines several areas: inquiry, concepts, the community and ethical-political engagement. (shrink)

This collection of original essays, written by scholars from disciplines across the humanities, addresses a wide range of questions about love through a focus on individual films, novels, plays, and works of philosophy. The essays touch on many varieties of love, including friendship, romantic love, parental love, and even the love of an author for her characters. How do social forces shape the types of love that can flourish and sustain themselves? What is the relationship between love and passion? Is (...) love between human and nonhuman animals possible? What is the role of projection in love? These questions and more are explored through an investigation of works by authors ranging from Henrik Ibsen to Ian McEwan, from Rousseau to the Coen Brothers. (shrink)

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences. However, we believe that peer review is not always appropriate for the evaluation of controversial hypothetical science. We argue that (...) the process of peer review can be prone to bias towards ideas that affirm the prior convictions of reviewers and against innovation and radical new ideas. Innovative hypotheses are thus highly vulnerable to being “filtered out” or made to accord with conventional wisdom by the peer review process. Consequently, having introduced peer review, the Elsevier journal Medical Hypotheses may be unable to continue its tradition as a radical journal allowing discussion of improbable or unconventional ideas. Hence we conclude by asking the publisher to consider re-introducing the system of editorial review to Medical Hypotheses. (shrink)

How a group G can know that p has been the subject of much investigation in social epistemology in recent years. This paper clarifies and defends a form of non-supervenient, non-summative group knowledge: G can know that p even if none of the members of G knows that p, and whether or not G knows that p does not locally supervene on the mental states of the members of G. Instead, we argue that what is central to G knowing that (...) p is whether G has an epistemic structure that is functioning appropriately in accord with the action-related purposes of the group, and this structure may include non-agential elements such as devices that retain or process information. We argue that recent objections to non-summative group knowledge given by Jennifer Lackey do not in fact succeed in undermining the view, but do help to clarify the nature of non-summative group knowledge. The main upshot of our response to Lackey’s objections is that groups put their knowledge into action in ways that often differ from how individuals do so, and social epistemologists should be careful to notice these differences, especially insofar as groups often structure themselves by employing various epistemically-relevant devices. (shrink)

In this essay we expand the notion of thinking by emphasizing the provocation and urgency to think and by reconceptualizing thinking as an embodied practice. The aim is to expand Lipman and Sharp’s approach to philosophical inquiry with children and show how other ways of thinking can be included. We strive to unfold a way of “thinking” that is both different from rationality (critical thinking) as well as from creative and caring thinking. In the first part of the paper, we (...) discuss the merits of Lipman and Sharp’s critical, creative and caring thinking within the Community of Philosophical Inquiry (CPI). We then expand Lipman/Sharp’s philosophical method through Ekkehart Marten’s Five-finger Model, which allows for different philosophical approaches. In the second half of the paper, we draw on Martin Heidegger’s What is called thinking? to develop his concept of the “call” to think together with its related notions of provocation and urgency. Building on this, we draw on Maurice Merleau-Ponty to show how this call is not an intellectual activity or mere exercise of the “mind” but rather affects our entire existence. As such, thinking becomes a response to an existential urgency that is an embodied practice. Using concepts like embodiment, affect, and sensibility, we try to widen our conception of thinking in a CPI. Finally, we hope this will allow facilitators to hear the unique voice of every child so that no one is left unheard. (shrink)

Oversight of human gene transfer research presents an important model with potential application to oversight of nanobiology research on human participants. Gene therapy oversight adds centralized federal review at the National Institutes of Health's Office of Biotechnology Activities and its Recombinant DNA Advisory Committee to standard oversight of human subjects research at the researcher's institution and at the federal level by the Office for Human Research Protections. The Food and Drug Administration's Center for Biologics Evaluation and Research oversees human (...) gene transfer research in parallel, including approval of protocols and regulation of products. This article traces the evolution of this dual oversight system; describes how the system is already addressing nanobiotechnology in gene transfer: evaluates gene therapy oversight based on public opinion, the literature, and preliminary expert elicitation; and offers lessons of the gene therapy oversight experience for oversight of nanobiotechnology. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial (...) conducted across five school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

Notes and Records: the Royal Society Journal of the History of Science Volume 77Issue 4 01 November 2023 Table of Contents -/- [1] C. T. Wolfe, “The life of matter: early modern vital matter theories,” Notes and Records: the Royal Society Journal of the History of Science, vol. 77, no. 4, pp. 673–675, Nov. 2023. -/- [2] G. Giglioni, “Large as life: Francis Bacon on the animate matter of plants,” Notes and Records: the Royal Society Journal of the History (...) of Science, vol. 77, no. 4, pp. 677–696, Nov. 2023. -/- [3] L. Georgescu, “Cavendish on life,” Notes and Records: the Royal Society Journal of the History of Science, vol. 77, no. 4, pp. 697–715, Nov. 2023. -/- [4] A. Clericuzio, “Thomas Willis’ iatrochemistry and the activity of matter,” Notes and Records: the Royal Society Journal of the History of Science, vol. 77, no. 4, pp. 717–732, Nov. 2023. -/- [5] R. Garau, “Gassendi’s second thought. From a materialistic picture of cognition to the defence of dualism: the lasting influence of the polemic with Descartes,” Notes and Records: the Royal Society Journal of the History of Science, vol. 77, no. 4, pp. 733–751, Nov. 2023. -/- [6] T. Demeter, “Sympathetic Organizations: body, mind, and society in Robert Whytt and David Hume,” Notes and Records: the Royal Society Journal of the History of Science, vol. 77, no. 4, pp. 753–769, Nov. 2023. -/- [7] P. Pecere, “Materialism, Lebenskraft and the limits of science: metaphysical vitalism in post-Kantian scenarios,” Notes and Records: the Royal Society Journal of the History of Science, vol. 77, no. 4, pp. 771–787, Nov. 2023. -/- . (shrink)

With the originality and energy that have marked his earlier works, Eric Wolf now explores the historical relationship of ideas, power, and culture. Responding to anthropology's long reliance on a concept of culture that takes little account of power, Wolf argues that power is crucial in shaping the circumstances of cultural production. Responding to social-science notions of ideology that incorporate power but disregard the ways ideas respond to cultural promptings, he demonstrates how power and ideas connect through the medium of (...) culture. Wolf advances his argument by examining three very different societies, each remarkable for its flamboyant ideological expressions: the Kwakiutl Indians of the Northwest Pacific Coast, the Aztecs of pre-Hispanic Mexico, and National Socialist Germany. Tracing the history of each case, he shows how these societies faced tensions posed by ecological, social, political, or psychological crises, prompting ideological responses that drew on distinctive, historically rooted cultural understandings. In each case study, Wolf analyzes how the regnant ideology intertwines with power around the pivotal relationships that govern social labor. Anyone interested in the history of anthropology or in how the social sciences make comparisons will want to join Wolf in _Envisioning Power_. (shrink)

There is a gap between health economic evaluation methods and the value judgments of coverage decision makers, at least in Germany. Measuring preference satisfaction has been claimed to be inappropriate for allocating health care resources, e.g. because it disregards medical need. The existing methods oriented at medical need have been claimed to disregard non-consequentialist fairness concerns. The aim of this article is to propose a new, contractarian argument for justifying needs-based economic evaluation. It is based on consent rather (...) than maximization of some impersonal unit of value to accommodate the fairness concerns. This conceptual paper draws upon contractarian ethics and constitution economics to show how economic evaluation can be viewed as an institution to overcome societal conflicts in the allocation of scarce health care resources. For this, the problem of allocating scarce health care resources in a society is reconstructed as a social dilemma. Both disadvantaged patients and affluent healthy individuals can be argued to share interests in a societal contract to provide technologies which ameliorate medical need, based on progressive funding. The use of needs-based economic evaluation methods for coverage determination can be interpreted as institutions for conflict resolution as far as they use consented criteria to ensure the social contract’s sustainability and avoid implicit rationing or unaffordable contribution rates. This justifies the use of needs-based evaluation methods by Pareto-superiority and consent. The view of economic evaluation presented here may help account for fairness concerns in the further development of evaluation methods. This is because it directs the attention away from determining some unit of value to be maximized towards determining those persons who are most likely not to consent and meeting their concerns. Following this direction in methods development is likely to increase the acceptability of health economic evaluation by decision makers. (shrink)

The Covid‐19 pandemic has exposed four myths in bioethics. First, the flood of bioethics publications on how to allocate scarce resources in crisis conditions has assumed authorities would declare the onset of crisis standards of care, yet few have done so. This leaves guidelines in limbo and patients unprotected. Second, the pandemic's realities have exploded traditional boundaries between clinical, research, and public health ethics, requiring bioethics to face the interdigitation of learning, doing, and allocating. Third, without empirical research, the (...) success or failure of ethics guidelines remains unknown, demonstrating that crafting ethics guidance is only the start. And fourth, the pandemic's glaring health inequities require new commitment to learn from communities facing extraordinary challenges. Without that new learning, bioethics methods cannot succeed. The pandemic is a wake‐up call, and bioethics must rise to the challenge. (shrink)

Jesper Kallestrup has provided an insightful response to our paper, “Epistemic Structure in Non-Summative Social Knowledge”. Kallestrup identifies some important issues pertaining to our non-summative, non-supervenient account of group knowledge which we did not address in our original paper. Here, we develop our view further in light of Kallestrup’s helpful reply.

Research on the development of Theory of Mind has often focused predominantly on belief attribution, but recently moves have been made to include also other mental states. This includes especially factive mental states like knowledge, where factive Theory of Mind may turn out to be more basic than non-factive Theory of Mind. I argue that children’s early pretend play also carries important implications for Theory of Mind research. Although pretend play does not directly provide evidence of Theory of Mind in (...) young children, it provides evidence of an early ability to handle inconsistent representations, although this ability to access these inconsistent representations may be contingent on external support. Dealing with inconsistent representations is arguably an important component of non-factive Theory of Mind and underlies belief attribution. This carries important implications for debates in Theory of Mind, especially concerning the relationship between factive and non-factive Theory of Mind. I also consider to what extent the findings from pretend play can be extended to support and illuminate the findings from the implicit false belief task. (shrink)

The original, prescientific Western belief that the mantis is a pious, helpful creature became a widely held explanation for the mantid's unique resting posture, and for one of its cryptic displays. This belief was a characteristic part of a broader discourse about nature in which ancient authority, religious beliefs, and superstition, but few original observations, mixed freely. Gradually, the belief in mantid gentleness and piousness became a commonplace through the continual retelling of the myths and superstitions surrounding this fascinating insect.By (...) the seventeenth century, a growing interest in observation had begun to replace blind reliance on established wisdom and ancient authority. However, the various young sciences to which the period gave rise did not progress equally, and neither did the subdisciplines within each scientific field; biology, especially entomology, was particularly slow to free itself from past beliefs and contemporary superstitions. In the specific case of the praying mantis, the situation may have been at its worst.Early observers of nature found evidence that seemed, at first, to disconfirm the well-established belief that mantids are gentle creatures. These few observers, faced with startling firsthand information about mantid voraciousness, created a new characterization of mantids as merciless predators and then often juxtaposed the two images in their descriptions. However, it was not until the beginning of the nineteenth century that the two characterizations-gentleness versus cruelty— became reconciled.An amalgamation of these seemingly mutually exclusive characterizations was achieved by an interesting accommodation of each to the other. That is, while it could no longer be maintained that mantids are simply gentle insects, neither could it be accepted that they are all cruelty and viciousness. The melding of the two characterizations yielded a hybrid explanation which claimed that the praying mantis actually hastwo sides to its character! On the one hand, and like other creatures, mantids must nourish themselves, and do so quite reasonably by capturing small insects for food. However, even when “well nourished,” and without “the excuse of hunger,” their other, vicious side may surface; when this happens, the darkest of behaviours, cannibalism, is the result.To understand the remainder of the story one must pause to consider what had happened in the other sciences up to this point. In the mid-seventeenth century, professional scientific societies were established throughout Europe. The societies, and the various journals and periodicals that they produced or encouraged, represented an institutionalization of both science and its special, structured discourse. However, as we have stated, entomology lagged behind; and in the case of some insects, superstitions and anthropomorphisms did not fade from descriptions of their behavior for centuries to come.By the time the new scientific discourse was applied to mantids the creatures were already firmly shackled with a dual personality, and this assumption was never challenged. In fact, it was functionally impossible to disconfirm. Captures of small prey were considered part of the mantid's normal side; captures of large prey were considered part of the mantid's abnormal side. There was no alternative explanation.As luck would have it, by the time that the strictures of scientific discourse had tightened sufficiently to disallow the use of anthropomorphisms in the explanation of insect behavior, another acceptable explanation of mantid cannibalism became immediately available: cannibalism became part of mantid mating behavior. That is, the fundamental explanatory model remained unchanged; it was merely couched in more appropriate terms. The acceptance of this new explanation for cannibalism was virtually immediate and complete. For instance, no one ever asked the following questions: If the headless male remains able to mate as a putative precaution against female cannibalism, for what reason does the headless female remain able to fashion “a perfectly constructed ootheca”? Or: If female-on-male cannibalism plays a role in mating behavior, what role is played by genderindifferent cannibalism, especially that among immature mantids? The latter phenomena were simply ignored — they were just uninteresting artifacts of insect life. However, the grand logic of nature was immediately apparent in the headless male's ability to mate. The ruling theory, to use Chamberlin's term, had been able to accommodate itself to, and assimilate, the new scientific discourse. It remained unscathed.A persistent question posed by several historians of this particular topic has been, Why did not the results of Ken Roeder's experiments debunk the myth that males are regularly cannibalized by the females with which they mate? The reason, which we hope is now clear, is that there were two interdependent ruling theories operating here. If one accepts the argument that mantids' cannibalism is simply a normal part of their prey-catching behavior, then one attacks not only the theory that mantids have two separate predatory strategies, but also the more recent theory that mantids have evolved to be the ideal fly-catching machines. This second theory found its first confirming support in the centuries-old practice of feeding flies to captive mantids. Again, the disconfirming evidence of mantids eating prey of various sizes had no impact on the theory. Confirming observations were accepted: disconfirming observations were seen as anomalies.Additional confirmation of both ruling theories was garnered in experiments done in the mid-twentieth century. These experiments were based on the assumption that the original conceptualizations were correct, and consequently they did not test other hypotheses. The combined strength of the two theories is evidenced especially in the Raus' failure to account for the fact that their empirical observations were at odds with many of the conclusions that they drew, and in the fact that Roeder's work is still used to support the belief in the regularity of mating-related cannibalism despite the fact that Roeder, himself, argued the opposite. with both theories well entrenched, it is virtually impossible to promote an alternative theory of mantid behavior: namely, that mantids are generalized, opportunistic predators that manage to survivein spite of the fact that cannibalism sometimes occurs. (shrink)

Schools of economic ethics inspired by Buchanan propose viewing ethical conflicts as prisoners’ dilemmas to facilitate solutions based on Pareto-improving institutional changes. Given that healthcare is determined by complex institutional arrangements, it has been claimed that this approach is also suitable for business ethics in healthcare. To scrutinize this claim, this research systematically searched for studies reporting PD structures in healthcare. PubMed, EconLit, and EconBiz were searched to find articles in German and English. Study type, characteristics of the game, and (...) the proposed means to overcome the dilemma were extracted and analyzed for aspects supporting or challenging the claim. Across 53 studies, 68 descriptions of various dilemmas in healthcare and public health were identified. Many authors successfully developed proposals for institutional change to overcome these dilemmas. However, many of these analyses exhibited limitations such as oversimplifications or inconsistencies. Also, the quality of evidence on both the characteristics of dilemmas and the effectiveness of proposed solutions was very poor. The subsamples of studies that explicitly cited the ethical approach were disjunct from those that applied empirical methods to analyze the dilemmas. The large number of identified PDs indicates that economic ethics is relevant to healthcare. However, there is a need for further evidence to substantiate both the descriptive and prescriptive claims of this ethical theory. It should thus be seen as a complement that needs justification, rather than a substitute superior to other ethical frameworks. (shrink)

A certain reading of Descartes, which we refer to as ‘the embodied Descartes’, is emerging from recent scholarship on L’Homme, in keeping with the interpretive trend which emphasizes Descartes’s identity as a natural philosopher. This reading complicates our understanding of Descartes’s philosophical project: far from strictly separating human minds from bodies, the embodied Descartes keeps them tightly integrated, while animal bodies behave in ways quite distinct from those of other pieces of extended substance. Here, we identify three categories of embodiment (...) in contemporary readings of Descartes’s physiology: bodily health and function, embodied reflex and memory, and embodied cognition. All present more or less strong versions of the embodied Descartes. Together, they constitute a compelling reading of a Cartesian natural philosophy that, if not expressly antidualist, is an awfully long way from the canonical picture. (shrink)