While there is significant consensus that undergraduate medical education should include bioethics training, there is widespread debate about how to teach bioethics to medical students. Educators disagree about course methods and approaches, the topics that should be covered, and the effectiveness and metrics for UME ethics training. One issue that has received scant attention is the timing of bioethics education during medical training. The existing literature suggests that most medical ethics education occurs in the pre-clinical years. Follow-up studies indicate that (...) medical students in their clinical rotations have little recall or ability to apply ethics concepts that were learned in their pre-clinical training. Trainees also report a desire for medical ethics to be taught in the context of practical application, which would suggest that the timing of pre-clinical ethics education is flawed. However, moving bioethics training to the clinical years should not be assumed to be the solution to the problems of recall and theory application. We argue that the effectiveness of timing bioethics education will depend on when medical students witness or experience particular categories of ethical dilemmas during their training. Our overarching hypothesis is that ethics education will be most effective when the bioethics training on a particular topic correlates to experiential exposure to that ethical issue. The purpose of our current study was to describe medical students exposure to particular categories of ethical conflicts, dilemmas, or issues. Our results may help bioethics educators better strategize about the most effective timing of medical ethics training in UME. (shrink)

Joseph C. Pitt, based on his understanding of trust and of technology, makes the provocative argument that trusting technology is actually a matter of trusting people. I agree with Pitt’s conclusion but differ with him on the nature of trust. I contend, nonetheless, that my understanding of trust actually reinforces Pitt’s characterization of technology as “humanity at work.”.

Compiled by scholars at the court of Liu An, king of Huainan, in the second century B.C.E, _The Huainanzi_ is a tightly organized, sophisticated articulation of Western Han philosophy and statecraft. Outlining "all that a modern monarch needs to know," the text emphasizes rigorous self-cultivation and mental discipline, brilliantly synthesizing for readers past and present the full spectrum of early Chinese thought. _The Huainanzi_ locates the key to successful rule in a balance of broad knowledge, diligent application, and the penetrating (...) wisdom of a sage. It is a unique and creative synthesis of Daoist classics, such as the _Laozi_ and the _Zhuangzi_; works associated with the Confucian tradition, such as the _Changes_, the _Odes_, and the _Documents_; and a wide range of other foundational philosophical and literary texts from the _Mozi_ to the _Hanfeizi_. The product of twelve years of scholarship, this remarkable translation preserves _The Huainanzi_'s special rhetorical features, such as parallel prose and verse, and showcases a compositional technique that conveys the work's powerful philosophical appeal. This path-breaking volume will have a transformative impact on the field of early Chinese intellectual history and will be of great interest to scholars and students alike. (shrink)

The current Medicare prospective payment system has many positive incentives for hospitals to control costs. Hospitals are increasing outpatient surgery, decreasing admissions, decreasing length of stay, and decreasing use of ancillary services. These are just the effects that Congress and the Health Care Financing Administration hoped for to save the Medicare trust fund. However, there has been evidence of some adverse outcomes including premature discharge, “dumping” sicker patients and patients without insurance, and adverse impact on hospitals with specialty centers. We (...) examine these issues and present a possible solution based on a new Computerized Severity Index. (shrink)

This paper examines one particular justification for the screening and termination of embryos/fetuses which possess genetic features known to cause disability. The particular case is that put forward in several places by John Harris. He argues that the obligation to prevent needless suffering justifies the prevention of the births of disabled neonates. The paper begins by rehearsing Harris's case. Then, drawing upon claims advanced in a recent paper in the Journal of Medical Ethics, it is subjected to critical scrutiny, focusing (...) on Harris's “suffering claim” .1 It is argued that the suffering claim must be false if understood as an empirical claim. And, even if understood as a conceptual truth, it mistakenly assimilates the concepts of harm and suffering. Finally, again focusing on Harris's recent work in this area, his characterisation of disability as a “harmed condition” is shown not to apply in the case of at least some moderate forms of intellectual disability. (shrink)

Primary works on Huang-Lao Taoism and Yin-yang philosophy, lost for more than two thousand years, are translated and prefaced with an informative introduction.

In lieu of an abstract, here is a brief excerpt of the content:Consciousness and Machines:A Commentary Drawing on Japanese PhilosophyS. D. Noam Cook (bio)Viewed from within the great unity of consciousness, thinking is a wave on the surface of a great intuition.Kitarō NishidaIntroductionRecent developments in AI have made the long-standing debate about what computers can and can't do a major public concern. What we understand the properties of such machines to be, and consequently how we design [End Page 305] and (...) deploy them, will increasingly shape how we live and how we understand ourselves. Thus, there is an urgent need for better understanding of these issues.Susan Schneider, in her book Artificial You: AI and the Future of Your Mind, offers an exceptionally careful and insightful examination of key issues entailed in how we understand AI and ourselves. One of her central concerns is how we might test for machine consciousness. Given the variations in design and function among current and projected AIs, Schneider sees no likely one-size-fits-all test. So, she offers a battery of different tests that she believes together will make such testing more reliable. This seems a wise approach, and reflects the conceptual and pragmatic care Schneider takes throughout the book.Similarly, it seems to me that the question of machine consciousness should also include various understandings of consciousness itself. What consciousness is taken to be has varied widely both historically and culturally. No commonly accepted single understanding has emerged, and may never emerge. Just as having a battery of tests might help us better assess possible machine consciousness, having different understandings of consciousness might give us a better understanding of what we are testing for. The two should work in tandem, each gauging and shaping the other.Like the development of computers themselves, the predominant thinking about AI has been shaped, in part, by key presuppositions of a scientific worldview, with its origins in Western thought and culture. Among these presuppositions are materialism, reductionism, and a primary focus on objective behavior. These are reflected in the common concern with observable behavior of physical aspects of the brain in efforts to understand human consciousness, which in turn has become a familiar model for work on machine consciousness. All this is important and valuable work. But, in the spirit of Schneider's cautions, it should not be taken as one-size-fits-all. Accordingly, I offer one view of consciousness from a different perspective.In what follows, I sketch out an understanding of consciousness that draws on Japanese philosophy, particularly that of the highly influential early twentieth-century Japanese philosopher Kitarō Nishida (1870–1945). I then explore how the tests for machine consciousness that Schneider proposes might be viewed from that perspective.Consciousness: A Perspective from Japanese PhilosophyConsciousness was a central concern for Nishida, whose philosophy is deeply informed by Japanese culture and by Zen theory and practice. As one might expect from such a philosopher, Nishida's exploration of consciousness is not concerned with properties of the brain, but with what we might discern through disciplined reflection on the experience of our own consciousness. Ultimately, he views consciousness as an organic whole [End Page 306] of systemically organized interrelationships of activities and sensations within our subjective experience. This may be understood by first considering 'nothingness'.For Nishida, nothingness does not suggest an ultimate and absolute vacuity, as is often understandably assumed. In Nishida's sense, it is a singular "place" that mirrors the multifaceted world of our common experience. In understanding this, I am told by native Japanese speakers that the English word 'nothingness' has an advantage over the Japanese equivalent, 'mu', in that 'nothingness' can usefully be broken down as 'nothing-ness'. This suggests that nothingness is a state of consciousness where what we commonly experience as distinct (self, other, world, blue, ache, joy, etc.) is indistinct, a state of unified experience. This is consciousness without our finding or discriminating in it the myriad "things" of common experience, but rather a "pure experience" of a singular whole. Nishida introduces his concept of "pure experience" as follows:To experience means to know facts just as they are, to know in accordance with facts by completely relinquishing one... (shrink)

The practice of prenatal screening for disability is sometimes objected to because of the hurt and offence such practices may cause to people currently living with disabilities. This objection is commonly termed “the expressivist objection”. In response to the objection it is standardly claimed that disabilities are analogous to illnesses. And just as it would be implausible to suppose reduction of the incidence of illnesses such as flu sends a negative message to ill people, so it is not plausible to (...) suppose prevention of disability sends a negative message to disabled people. The expressivist objection hinges, however, upon a view of the relationship between disability and self identity which sees disability as part of the identity of the disabled person, in a way in which illnesses such as flu cannot be. This possibility is generally not considered in critiques of the expressivist objection. In this paper, an “identity claim” to the effect that disabilities can be identity constituting is accepted and the force of the expressivist argument is reconsidered in the light of its acceptance. It is concluded that even when such an identity claim is accepted, the expressivist objection is still not morally compelling. (shrink)

In this article we examine ethical aspects of the involvement of children in clinical research, specifically those who are incapable of giving informed consent to participate. The topic is, of course, not a new one in medical ethics but there are some tensions in current guidelines that, in our view, need to be made explicit and which need to be responded to by the relevant official bodies. In particular, we focus on tensions between the World Medical Association Declaration of Helsinki, (...) and the guidance offered by the British Medical Association, the Royal College of Paediatrics and Child Health , and the Council for International Organizations of Medical Sciences. We conclude with a call for these organisations to make their guidance explicit in relation to the World Medical Association Declaration. (shrink)

Background: Despite potential benefits of the return of research results to research participants, the TriCouncil Policy Statement , which reflects Canadian regulatory ethical requirements, does not require this. The policies of Canadian research ethics boards are unknown.Objectives: To examine the policies of Canadian university based REBs regarding returning results to research participants, and to ascertain if the presence/absence of a policy may be influenced by REB member composition.Design: Email survey of the coordinators of Canadian university based REBs to determine the (...) presence/absence of a policy on return of research results to research participants both during an ongoing study and at conclusion. REB coordinators were asked to return a copy of the policy or guidelines and to describe the member composition of their REB.Findings: Of 50 REBs that were contacted 34 responded and 22 met the inclusion criteria. Two had a policy that governed the return of research results while on a study, and seven following the completion of a study. Presence of an ethicist or a lawyer on the REB did not influence the presence/absence of such policies. No REBs had specific guidelines describing how participants should be informed of results.Conclusions: Most REBs did not require researchers to disclose study results to research participants either during or following a study. Thus this study identifies an ethical shortcoming in the conduct of human research in Canada. It has also demonstrated that there are no clear recommendations by REBs to facilitate the return of results to participants following research projects. (shrink)

Einstein, in his “Zur Elektrodynamik bewegter Körper”, gave a physical (operational) meaning to “time” of a remote event in describing “motion” by introducing the concept of “synchronous stationary clocks located at different places”. But with regard to “place” in describing motion, he assumed without analysis the concept of a system of co-ordinates.In the present paper, we propose a way of giving physical (operational) meaning to the concepts of “place” and “co-ordinate system”, and show how the observer can define both the (...) place and time of a remote event. Following Einstein, we consider another system “in uniform motion of translation relatively to the former”. Without assuming “the properties of homogeneity which we attribute to space and time”, we show that the definitions of space and time in the two systems are linearly related. We deduce some novel consequences of our approach regarding faster-than-light observers and particles, “one-way” and “two-way” velocities of light, symmetry, the “group property” of inertial reference frames, length contraction and time dilatation, and the “twin paradox”. Finally, we point out a flaw in Einstein’s argument in the “Electrodynamical Part” of his paper and show that the Lorentz force formula and Einstein’s formula for transformation of field quantities are mutually consistent. We show that for faster-than-light bodies, a simple modification of Planck’s formula for mass suffices. (Except for the reference to Planck’s formula, we restrict ourselves to Physics of 1905.). (shrink)