Volume 25, Issue 2, February 2025, Page 36-38.

As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

On Advaita philosophy; Sanskrit text with commentary and translation.

While the phenomenon of ‘moral distress’ has been of interest to the nursing community since Jameton first described it in 1984, moral distress is now understood to effect healthcare professionals...

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)

In recent years, the phenomenon of moral distress has been critically examined—and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re‐examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral (...) action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re‐centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of ‘narrow' moral distress and the value of re‐considering moral distress. Finally, we provide an action‐oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency. (shrink)

While Jameton’s (1984) definition of moral distress has been embraced by researchers and scholars for recognizing the many constraints that nurses experience on their moral agency, it has also been...

Supported decision making, as outlined by Peterson et al. highlights real-world challenges in the messy context of clinical care. We agree with Peterson et al. that patients...

Herrera-Ferrá et al.’s (2023) attention to the cultural context of the neurorights movement contributes to the growing conversation on establishing neurorights in response to advancements in neuros...

Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward “solution.” Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an ethical issue related to patient care that requires deeper exploration, (...) rather than evidencing identification of the “right” course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient’s values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action. (shrink)

Enck and Condley (2025) put forward a robust and plausible account of agent-regret. The authors argue that agent-regret, originating from the work of Bernard Williams, highlights two problems with...

Russell articulates compelling reasons that bioethicists and health care professionals should take individual responsibility for deconstructing structural injustices in healthcare through in...

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

A proposed state administrative rule would have required medical ethicists to approve certain aspects of gender-affirming care. The authors argue the proposed rule lacked appropriate justification compared to other instances of state-mandated ethics oversight and would undermine trust, raise practical challenges, and send harmful messages to society, patients, and providers.

Layers of complexity arise when a person arrives in an Intensive Care Unit (ICU) due to self-harm intended to end their life and when there is known past personal trauma. We highlight three importa...

Sankary et al. (2022) report the results of an empirical study on research participant experiences of exiting research at the end of clinical trials of deep-brain-stimulation (DBS) and responsive n...

In their article, Sankary et al. (2022) provided important preliminary findings on how research participants exiting from clinical trials engage in decisions related to the removal or post-trial us...

It is argued that the so-called fitting attitude- or buck-passing pattern of analysis may be applied to personal values too if the analysans is fine-tuned in the following way: An object has personal value for a person a, if and only if there is reason to favour it for a’s sake. One benefit with it is its wide range: different kinds of values are analysable by the same general formula. Moreover, by situating the distinguishing quality in the attitude rather than (...) the reason part, the analysis admits that personal value is recognizable as a value not only by the person for whom it has personal value, but for everyone else too. We thereby avoid facing two completely different notions of value, viz., one pertaining to impersonal value, and another to personal value. The analysis also elucidates why we are justified in our concern for objects that are valuable for us; if value just is, as it is suggested, the existence of reasons for such a concern, the justification is immediately forthcoming. (shrink)

Chemical structures are among the trademarks of our profession, as surely chemical as flasks, beakers and distillation columns. When someone sees one of us busily scribbling formulas or structures, he or she has no trouble identifying a chemist. Yet these familiar objects, which accompany our work from start to end, from the initial doodlings (Fig. I) to the final polished artwork in a publication (Fig. II), are deceptively simple. They raise interesting and difficult questions about representation. It is the intent (...) of this article to reflect upon molecular graphics. (shrink)

This distinction has sometimes been read as purely epistemic, resting not on things, but on our knowledge of them: there is one world, not two, though it may be apprehended in two ways. But this view is patently at odds with the text. Knowledge and opinion are δυνάμεις, "faculties," to be distinguished and defined by their objects, no less than by the state of mind they produce, and Plato clearly states that the fallibility and unclearness of opinion is rooted in (...) the relative unreality of opinables. (shrink)

In his article ‘A Cavalry Unit in the Army of Antigonus Monophthalmus: Asthippoi’, N. G. L. Hammond argues that the reading of the manuscript R at Diodorus 19. 29. 2 should be retained and that we should read ⋯π⋯ π⋯σι δ⋯ το⋯ς τε ⋯σθ⋯ππους ⋯νομαζομ⋯νους κα⋯ τοὺς ⋯κ τ⋯ν ἄνω κατοικο⋯ντων ⋯κτακοσιο⋯ς. The readings of F and its copy X, ⋯νθ⋯ππους, and the commonly accepted conjecture of Wesseling ⋯μɸ⋯ππους, should both be abandoned. Hammond's arguments for retaining this reading are that (...) between the variant readings of R and F, R ‘is the more often correct’ ; ⋯σθ⋯ππους, the reading of R, is preferable to F's ⋯νθ⋯ππους on the principle of ‘lectio difficilior’; the ‘difficulty’ of his lectio difficilior is made less by the arguments presented by A. B. Bosworth, 245 ff.), for the restoration at several places in the text of Arrian's Anabasis the word ⋯σθ⋯ταιροι, in place of the editorial emendation of πεζ⋯ταιροι. ‘For just as asthetairoi meant an élite group of Macedonian infantrymen,’ says Hammond, ‘so asthippoi should mean an élite group of Macedonian cavalrymen.’ He then proceeds to examine the passage and its context in an attempt to find confirmation of this proposition and comes to the conclusion that Diodorus' text says that there were 800 cavalrymen, broken into two groups, the asthippoi and ‘the men from the up-country settlers’; these, though having different names, had a close relationship to each other, as is shown by their being brigaded together. Following his derivation of asthetairoi as meaning ‘townsmen-companions’, i.e. companions recruited from the towns of Upper Macedonia, he argues that asthippoi were cavalry recruited from the towns of Upper Macedonia and that τοὺς ⋯κ τ⋯ν ἄνω κατοικο⋯ντων means ‘the sons of settlers in up-country Macedonia’. These 800, says Hammond, were both among Antigonus' best troops and ‘were Macedonians from Europe’. We thus appear, on Hammond's interpretation, to have here a group of 800 Macedonian élite cavalrymen, all of whom were recruited in Upper Macedonia's townships, but of whom some were chosen to be the cavalry-equivalent of the élite ‘townsmen-companions’ by their title of ‘townsmen-cavalry’, whilst the others, similarly recruited – but perhaps of a younger generation? – had no particular distinguishing title beyond ‘sons of settlers in up-country Macedonia’.Now, while it would be exciting to be able to add another one, possibly two Macedonian cavalry units to the Macedonian army of Philip, Alexander and the Successors, there are several aspects of Hammond's arguments that, it seems to me, are less than convincing. Thus, whilst it seems beyond reasonable doubt that ⋯σθ⋯ταιροι should be retained in the text of Arrian, appearing, as it does, six times, this is not an argument that ⋯σθ⋯ππους should be read in Diodorus' text. Both it and F's reading of ⋯νθ⋯ππους are hapax legomena and it is possible that both readings are wrong. But even if we retain ⋯σθ⋯ππους as the correct reading, Hammond's explanation of its meaning is open to objection on several counts. (shrink)

We generalize two well-known model-theoretic characterization theorems from propositional modal logic to first-order modal logic. We first study FML-definable frames and give a version of the Goldblatt–Thomason theorem for this logic. The advantage of this result, compared with the original Goldblatt–Thomason theorem, is that it does not need the condition of ultrafilter reflection and uses only closure under bounded morphic images, generated subframes and disjoint unions. We then investigate Lindström type theorems for first-order modal logic. We show that FML has (...) the maximal expressive power among the logics extending FML which satisfy compactness, bisimulation invariance and the Tarski union property. (shrink)

As far as the history of logic is concerned, late nineteenth and twentieth century Central and Eastern Europe seem oddly obscure. The work of several influential individuals or national schools is...

Volume 28, Issue 1, January 2020, Page 202-204.

On May 24, 1995, the American Medical Association Council on Ethical and Judicial Affairs issued a rather controversial opinion that it is ethically permissible to use anencephalic infants as living organ donors. Approximately 1,000 to 2,000 infants are born each year in the United States with anencephaly, a congenital birth defect whereby the infant has no forebrain and cerebrum. Without higher brain functions, the infants can never experience consciousness, thoughts, emotions, or pain. Fewer than half survive more than a day, (...) and more than 90 percent die within one week. However, by the time brain death occurs in anencephalic infants, their organs are no longer suitable for donor purposes because they have deteriorated beyond use.In 1988, the AMA Council declared that it is ethical to use the infants as organ donors only after they have died. Now the Council has revised that opinion, and it proposes to allow removal of organs before death, as long as the parents consent and two doctors concur in the diagnosis of anencephaly. (shrink)

In this paper, I use insights from post-structuralist anarchism to consider the relationship between a sense of the future, or “futurity”, and the notion of utopia for anarchist movements. At issue is whether anarchism requires a vision or sense of the future at all and, if so, whether that futurity should be utopian. Drawing from the post-structuralist anarchism of Todd May, Saul Newman, and Lewis Call, I consider the problems with utopia, as well as the potential irrelevance or impossibility of (...) even thinking the future. I then argue for the necessity of both and contend that post-structuralist anarchism does not preclude either futurity or provisional forms of utopia. I conclude by sketching the outlines of a utopia that would be acceptably post-structuralist and acceptably anarchist. (shrink)

Daniel Dennett and others have suggested that qualia and introspectible phenomena do not exist. Dennett's account of consciousness, along with several related approaches, has been called illusionism by Keith Frankish. Frankish's analysis is helpful and provocative. As currently presented, however, his 'strong' version of illusionism suffers from several basic confusions, particularly regarding its relationship to eliminative materialism. This paper contrasts strong illusionism with an alternative that is easier to understand and more sharply focused -- fallibilist experiential realism, or, less technically, (...) modest realism. Fallibilist realism affirms the existence of experiential states that are commonly considered qualitative and phenomenal, but shares Frankish's agenda of thoroughly re-evaluating our judgments about such experiences. To illustrate the advantages of modest realism, I compare the ways illusionism and modest realism address two challenging puzzles: explaining how qualitative differences among sensory experiences could be constituted by differences among neural states, and explaining how neural states could constitute any conscious experiences whatsoever. (shrink)

A fitting-attitude analysis which understands value in terms of reasons and pro- and con-attitudes allows limited wriggle room if it is to respect a radical division between good and good-for. Essentially, its proponents can either introduce two different normative notions, one relating to good and the other to good-for, or distinguish two kinds of attitude, one corresponding to the analysis of good and the other to good-for. It is argued that whereas the first option faces a counterintuitive scope issue, an (...) attitudinal approach couched in terms of ‘for someone's sake’ attitudes has the unwelcome consequence that whatever is good for someone is also necessarily good. It is argued that this consequence can be avoided if we modify the standard way of formulating the fitting-attitude analysis of final impersonal value. (shrink)