In response to the many changes currently going on in health care, this book offers the combined insight and wisdom of a stellar group of scholars and professionals with extensive experience in the health care field. The book opens with a look at people's actual experience of health care today, from four different perspectives. It then addresses foundational questions, including the nature of medicine, nursing, and justice. Surveyed next are the changing economics of health care as well as the impact (...) of these changes on such areas as mental health care, long-term care, health care for minorities, and legal malpractice. The closing section of the book assesses from a Christian perspective available constructive alternatives, including creative funding strategies with special attention to the needs of poor persons, physician unions, and the use of "alternative medicine" therapies. (shrink)

The management of commons is now at the centre of researchers’ attention in many branches of science, particularly those related to the human or social sciences. This paper seeks to demonstrate how civil society participation in common goods or resources is not only possible but is also desirable for society because of the medium and long-term benefits it offers involved and/or affected parties. To this end, we examine the falsity of the discourse underlying the supposed incompetence of civil society (...) to cooperate interpersonally in the pursuit of common objectives, and also analyse a specific example of the necessary and possible participation of civil society in managing common goods through biobanks.La gestión del bien común se ha convertido actualmente en centro de atención para diferentes ramas de la ciencia, especialmente aquellas vinculadas con lo humano y lo social. El presente estudio busca mostrar cómo la participación de la sociedad civil en la gestión de este tipo de bienes o recursos no sólo es posible, sino deseable para la sociedad por los beneficios que reporta a las partes implicadas y/o afectadas a medio y largo plazo. Para ello, se atenderá la falsedad del discurso sobre el cual se asienta la supuesta incompetencia de la sociedad civil para poder cooperar interpersonalmente en busca de objetivos comunes, así como se analizará un ejemplo concreto de la necesaria y posible participación de la sociedad civil en la gestión del bien común a través de los centros de recursos biológicos (brcs). (shrink)

The National Center for Biomedical Ontology is a consortium that comprises leading informaticians, biologists, clinicians, and ontologists, funded by the National Institutes of Health (NIH) Roadmap, to develop innovative technology and methods that allow scientists to record, manage, and disseminate biomedical information and knowledge in machine-processable form. The goals of the Center are (1) to help unify the divergent and isolated efforts in ontology development by promoting high quality open-source, standards-based tools to create, manage, and use ontologies, (2) to create (...) new software tools so that scientists can use ontologies to annotate and analyze biomedical data, (3) to provide a national resource for the ongoing evaluation, integration, and evolution of biomedical ontologies and associated tools and theories in the context of driving biomedical projects (DBPs), and (4) to disseminate the tools and resources of the Center and to identify, evaluate, and communicate best practices of ontology development to the biomedical community. Through the research activities within the Center, collaborations with the DBPs, and interactions with the biomedical community, our goal is to help scientists to work more effectively in the e-science paradigm, enhancing experiment design, experiment execution, data analysis, information synthesis, hypothesis generation and testing, and understand human disease. (shrink)

This essay explores how indigenous knowledge about plant and animal remedies was gathered, classified, tested, and circulated across wide networks of exchange for natural knowledge between Europe and the Americas. There has been much recent interest in the “bioprospecting” of local natural resources—medical and otherwise—by Europeans in the early modern world and the strategies employed by European travellers, missionaries, or naturalists have been well documented. By contrast, less is known about the role played by indigenous and Creole intermediaries in this (...) process. And yet, the transmission of knowledge between indigenous communities and the European cabinet was neither transparent nor natural, and often involved epistemological, linguistic, and religious obstacles. Drawing on printed and manuscript collections of indigenous remedies, written in colonial Mexico between the sixteenth and the eighteenth centuries, I focus on how local intermediaries, like creoles scholars, sought to overcome such obstacles by observing indigenous uses of remedies, by studying indigenous languages and by producing natural histories and pharmacopoeias in indigenous languages. Ultimately, behind the Creole participation in the transmission of indigenous remedies, one can point to political and cultural interests and to inclusive definitions of knowledge, which cut across oppositions between science and superstition, cabinet and field, centre and periphery. (shrink)

Data center technology changes the mode of computing. Traditional DCs consist of a single layer and only have Ethernet connections among switches. Those old-fashioned DCs cannot fulfill the high resource demand compared with today’s DCs. The architectural design of the DCs is getting substantial importance and acting as the backbone of the network because of its essential feature of supporting and maintaining the rapidly increasing Internet-based applications which include search engines and social networking applications. Every application has its parameters, (...) like latency and blocking in the DC network. Every data center network has its specialized architecture. It has a specific arrangement of layers and switches, which increase or decrease the DC network’s efficiency. We develop a simulation tool that comprises two different DC architectures: basic tree architecture and c-Through architecture. Using this simulation, we analyze the traffic behavior and the performance of the simulated DCN. Our main purpose is to focus on mean waiting time, load, and blocking with respect to the traffic within the DCN. (shrink)

We consider an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.

This book highlights the relevance of the grand traditions of the humanities as an untapped resource for business-world problems. In a time where the humanities are viewed as in decline or in threat of collapse altogether, this book enacts and extends the best of the humanities toward prevailing challenges within the complex realities of our current cultural moment. The book presents how the humanities can contribute to humanizing business and management. It explores and discusses various ways to integrate the (...) views and approaches of the humanities in business and management research, practice, and education responding to the unprecedented challenges of the Anthropocene. The relations between humanities and social sciences is also discussed, as models and theories of business and management are based on insights of social sciences. The book is an outcome of the “Humanities for Business” project of Princeton University Faith and Work Initiative, the European SPES Institute, Leuven, and the Business Ethics Center of Corvinus University of Budapest. It is of great value to researchers, students, policy makers and research institutions interested in using humanities for renewing and humanizing business and management. (shrink)

The National Center for Biomedical Ontology is now in its seventh year. The goals of this National Center for Biomedical Computing are to: create and maintain a repository of biomedical ontologies and terminologies; build tools and web services to enable the use of ontologies and terminologies in clinical and translational research; educate their trainees and the scientific community broadly about biomedical ontology and ontology-based technology and best practices; and collaborate with a variety of groups who develop and use ontologies and (...) terminologies in biomedicine. The centerpiece of the National Center for Biomedical Ontology is a web-based resource known as BioPortal. BioPortal makes available for research in computationally useful forms more than 270 of the world's biomedical ontologies and terminologies, and supports a wide range of web services that enable investigators to use the ontologies to annotate and retrieve data, to generate value sets and special-purpose lexicons, and to perform advanced analytics on a wide range of biomedical data. (shrink)

As an advanced network calculation mode, cloud computing is becoming more and more popular. However, with the proliferation of large data centers hosting cloud applications, the growth of energy consumption has been explosive. Surveys show that a remarkable part of the large energy consumed in data center results from over-provisioning of the network resource to meet requests during peak demand times. In this paper, we propose a solution to this problem by constructing a dynamic energy-efficient resource management scheme. (...) As a way of saving energy as well as maintaining cloud user’s quality of experience, the scheme presents a multitier cloud architecture by configuring physical machines into two pools: a hot pool and a warm pool. Each PM is configured with a resource search engine that finds an available virtual machine for the request, and a synchronous sleep mechanism is introduced to the warm pool. To analyze the end-to-end performance of the cloud system’s service with the proposed scheme, we establish a hybrid queueing system composed of three stochastic submodels by using a matrix-geometric solution. Accordingly, the average latency of requests and the energy-saving rate of the system are derived. Through numerical results, we show the influence of the synchronous sleep mechanism on the system performance. Moreover, from the perspective of economics, we build a system cost function to study the trade-off between different performance measures. An improved Salp Swarm Algorithm is presented to minimize the system cost and optimize the sleep parameter. (shrink)

This paper shows how proof nets can be used to formalize the notion of incomplete dependency used in psycholinguistic theories of the unacceptability of center embedded constructions. Such theories of human language processing can usually be restated in terms of geometrical constraints on proof nets. The paper ends with a discussion of the relationship between these constraints and incremental semantic interpretation.

We explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (...) (5) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention. (shrink)

Artificial intelligence is increasingly inputting into various human resource management functions, such as sourcing job applicants and selecting staff, allocating work, and offering personalized career coaching. While the use of AI for such tasks can offer many benefits, evidence suggests that without careful and deliberate implementation its use also has the potential to generate significant harms. This raises several ethical concerns regarding the appropriateness of AI deployment to domains such as HRM, which directly deal with managing sometimes sensitive aspects (...) of individuals’ employment lifecycles. However, research at the intersection of HRM and technology continues to largely center on examining what AI can be used for, rather than focusing on the salient factors relevant to its ethical use and examining how to effectively engage human workers in its use. Conversely, the ethical AI literature offers excellent guiding principles for AI implementation broadly, but there remains much scope to explore how these principles can be enacted in specific contexts-of-use. By drawing on ethical AI and task-technology fit literature, this paper constructs a decision-making framework to support the ethical deployment of AI for HRM and guide determinations of the optimal mix of human and machine involvement for different HRM tasks. Doing so supports the deployment of AI for the betterment of work and workers and generates both scholarly and practical outcomes. (shrink)

In this paper, the objects of philosophical reflection are the important lessons learned from a participatory action research program conducted by the Cordillera Studies Center of UP Baguio in Sagada, Mountain Province, in Northern Luzon, Philippines, which ran from March 1997 to February 2001. This research program used the Community Based Natural Resource Management (CBNRM) approach. Concepts of philosophy are made to re-describe “second order” concepts of theory, as well as “first order” concepts of community-based natural resource management (...) research, planning, testing, implementation, and monitoring. Concepts used in the context of field work are given philosophical re-descriptions in the form of the ontology of societal totality and nature, ethical thinking applied to land rights and to collective action of marginalized groups, and in the form of epistemological assertions concerning the interaction of indigenous knowledge and the conduct of scientific research itself on community-based natural resource management. (shrink)

While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim (...) to fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

At a time of increasing interest and advocacy in integrated and policy-oriented research, this paper offers an empirically-based view of the intellectual and practical challenges of undertaking such research. It analyses the experience of a long-standing university research and postgraduate training centre from 1973-2004: the Centre for Resource and Environmental Studies at The Australian National University. The paper discusses staff development issues, cross-disciplinary understanding, organisational requirements for collaborative research, postgraduate and early career considerations, a range of integrative (...) frameworks, and the tensions that arise for interdisciplinary research in the political and economic operating environments of modern universities. (shrink)

Using a new materialist line of questioning that looks at the agential potentialities of water and its entanglements with Big Data and surveillance, this article explores how the recent Snowden revelations about the National Security Agency have reignited media scholars to engage with the infrastructures that enable intercepting, hosting, and processing immeasurable amounts of data. Focusing on the expansive architecture, location, and resource dependence of the NSA’s Utah Data Center, I demonstrate how surveillance and privacy can never be disconnected (...) from the material infrastructures that allow and render natural the epistemological state of mass surveillance. Specifically, I explore the NSA’s infrastructure and the million of gallons of water it requires daily to cool its servers, while located in one of the driest states in the US. Complicating surveillance beyond the NSA, as also already imbricated with various social media companies, this article questions the emplacement and impact of corporate data centers more generally, and the changes they are causing to the landscape and local economies. I look at how water is an intriguing and politically relevant part of the surveillance infrastructure and how it has been constructed as the main tool for activism in this case, and how it may eventually help transform the public’s conceptualization of Big Data, as deeply material. (shrink)

In recent years, sequencing technologies have enabled the identification of a wide range of non-coding RNAs (ncRNAs). Unfortunately, annotation and integration of ncRNA data has lagged behind their identification. Given the large quantity of information being obtained in this area, there emerges an urgent need to integrate what is being discovered by a broad range of relevant communities. To this end, the Non-Coding RNA Ontology (NCRO) is being developed to provide a systematically structured and precisely defined controlled vocabulary for the (...) domain of ncRNAs, thereby facilitating the discovery, curation, analysis, exchange, and reasoning of data about structures of ncRNAs, their molecular and cellular functions, and their impacts upon phenotypes. The goal of NCRO is to serve as a common resource for annotations of diverse research in a way that will significantly enhance integrative and comparative analysis of the myriad resources currently housed in disparate sources. It is our belief that the NCRO ontology can perform an important role in the comprehensive unification of ncRNA biology and, indeed, fill a critical gap in both the Open Biological and Biomedical Ontologies (OBO) Library and the National Center for Biomedical Ontology (NCBO) BioPortal. Our initial focus is on the ontological representation of small regulatory ncRNAs, which we see as the first step in providing a resource for the annotation of data about all forms of ncRNAs. The NCRO ontology is free and open to all users. (shrink)

The rule of rescue describes the moral impulse to save identifiable lives in immediate danger at any expense. Think of the extremes taken to rescue a small child who has fallen down a well, a woman pinned beneath the rubble of an earthquake, or a submarine crew trapped on the ocean floor. No effort is deemed too great. Yet should this same moral instinct to rescue, regardless of cost, be applied in the emergency room, the hospital, or the community clinic? (...) -/- In health care, the desire to save lives at any cost must be reconciled with the reality of resource scarcity. As one example, the estimated cost for prophylactic Factor VIII to treat one patient with hemophilia for one year is $300,000. Costs of this magnitude have been accepted by public and private insurers in the developed world, even though, in principle, these sums could provide greater overall health benefit if allocated to pay for the unmet health care needs of many other patients. Looking forward, however, broad application of the rule of rescue will be increasingly untenable. But the moral instinct will remain: the desire to help those weakest among us, especially when their small numbers allow us to see them as unique individuals. What, then, is the ethical framework that can guide coverage and reimbursement decisions for orphan drugs into the future? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.1 (2002) 103-113 [Access article in PDF] Scope Note Update Searching Across Boundaries: National Information Resource on Ethics and Human Genetics* While indeed an historical moment, the announcement of the mapping of the human genome has been treated in the literature as a beginning—a new way to think about biology and the ways in which biological concepts are applied to medicine. Issues of (...) both Science and Nature magazines celebrated the event by establishing interdisciplinary websites where readers can access essays on aspects of genome mapping and directly link to databases to search for more information on the topics (IV. Genome Gateway 2001; The Human Genome 2001). Since 1994, the National Information Resource on Ethics and Human Genetics (NIREHG), a special project of the National Reference Center for Bioethics Literature (NRC), has been providing such an integrated information service on ethics and genetics. Designed to enable a wide range of users to go from annotated bibliographies (Scope Notes) and brief essays (called "enotes") to database searching, NIREHG fosters an interdisciplinary approach to research on ethics and genetics. Links are provided between and among Scope Notes and enotes to information maintained on the NIREHG site as well as to sources found throughout the Internet. In providing the following annotations added to NIREHG materials since 1997, the Kennedy Institute of Ethics Journal (in its online presence through Project Muse) becomes an additional forum for NIREHG links. "It is a rare and wonderful moment when success teaches us humility, and this, I argue, is precisely the moment at which we find ourselves at the end of the twentieth century" (IV. Keller 2000, p. 7). It is with both joy and humility that we celebrate the mapping of the human genome. [End Page 103] I. Genetic Testing Andrews, Lori B. Future Perfect: Confronting Decisions About Genetics. New York: Columbia University Press, 2001. 264 p.Noting the wide impact of genetic testing, Andrews discusses patient self concept, reproduction decisions, confidentiality, discriminations in health insurance and employment, the need for competent counseling, and the legal, ethical, and social regulations she deems important to help solve dilemmas arising from the tests and their ensuing ramifications. She describes three models, pointing out both advantages and problems: a medical model with physician gatekeepers, a public health model that could provide education as well some testing for those unable to afford tests, and a fundamental rights model that could give greater weight to individuals decisions about the use of health care services. The book has 85 pages of footnotes.American Society of Human Genetics. Social Issues Subcommittee on Familial Disclosure. Professional Disclosure of Familial Genetic Information. American Journal of Human Genetics 62 (2): 474-83, February 1998.The ASHG statement outlines points to consider: the general rule of confidentiality, exceptional circumstances that permit disclosure, and the ethical duty to inform patients about familial implications. Background discussion includes: ethical frameworks for disclosure of otherwise confidential information, the duty to warn under law, and international trends and positions.Boetzkes, Elisabeth. Genetic Knowledge and Third-Party Interests. Cambridge Quarterly of Healthcare Ethics 8 (4): 386-92, Summer 1999.Protection from the interests of insurers or prospective employers are discussed from the point of view of the ethical basis of the professional obligation to confidentiality as well as the right to privacy of those tested. However, the author supports family members, saying that "first-party resistance to disclosure may be overcome by weighty third-party claims."Chadwick, Ruth; Shickle, Darren; ten Have, Henk; and Wiesing, Urban, eds. The Ethics of Genetic Screening. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1999. 255 p.Twenty-one chapters and 23 authors provide views of genetic testing/screening in different European countries and offer brief discussions of sociological perspectives, moral and philosophical issues, privacy, reconciling liberty and the common good, and questions raised in genetic testing of children.Clayton, Ellen Wright. Genetic Testing in Children. Journal of Medicine and Philosophy 22 (3): 233-51, June 1997.Clayton argues that there is room for... (shrink)

Resource allocation is a central part of the decision-making process in any health care system. Resources have always been finite, thus the ethical issues raised are not new. The debate is now more open, and there is greater public awareness of the issues. It is increasingly recognised that it is the technology which determines resources. The ethical issues involved are often conflicting and relate to issues of individual rights and community benefits. One central feature of resource allocation is (...) the basing of decisions on the outcomes of health care and on their subsequent economic evaluation. The knowledge base is therefore of great importance as is the audit of results of clinical treatment. Public involvement is seen as an integral part of this process. For all parts of the process, better methodologies are required. (shrink)

This research aims to examine access to medical treatment during the COVID-19 pandemic for people living with disabilities. During the COVID-19 pandemic, the practical and ethical problems of allocating limited medical resources such as intensive care unit beds and ventilators became critical. Although different countries have proposed different guidelines to manage this emergency, these proposed criteria do not sufficiently consider people living with disabilities. People living with disabilities are therefore at a higher risk of exclusion from medical treatments as physicians (...) tend to assume they have poor quality of life, whereas access to medical treatment should be based on several parameters, including clinical data and prognosis. However, the COVID-19 pandemic shifts the medical paradigm from person-centred medicine to community-centred medicine, challenging the main ethical theories. We reviewed the main guidelines and recommendations for resources allocation and examined their position toward persons with disabilities. Based on our findings, we propose criteria for not discriminating against people with disabilities in allocating resources. The shift from person-centred to community-centred medicine offers opportunities but also risks sacrificing the most vulnerable people. The principle of reasonable accommodation must always be considered to guarantee the rights of persons with disabilities. (shrink)

The Brundtland Report popularized the concept of sustainable development as meeting “the needs of the present without compromising the ability for future generations to meet their own needs.” Twenty years later a United Nations report argued that current development strategies are inadequate for achieving sustainable development beyond 2015. Any approach to sustainability requires the negotiation and reconfiguration of resources, the consideration of the different stakeholder perceptions to uncertainty and its communication and the continuous recognition of potential threats. This paper aims (...) to enhance current frameworks on sustainability and contribute to management decision making by drawing upon the teachings of the Sikh Gurus. The paper begins with a summary of the main challenges in implementing the sustainability agenda; it then discusses a number of common sustainability frameworks and draws out a set of common limitations. The teachings of the Sikh Gurus are then introduced to provide unique insights into how their understanding of the universe might contribute to some general lessons that can support current sustainability frameworks and related decision making. Next, the paper considers System Archetypes, and in particular the “Limits to Growth”, as mechanisms for gaining insight into the patterns of behaviours that underpin the potential for less unsustainable futures. The paper combines the sustainability frameworks and Sikh teachings to suggest an integrated whole systems approach, across time and space that can throw a new light on the nexus of sustainable development. (shrink)

The Western world has a profound historical engagement with medicinal resources originating from China. Following the Opium War, missionaries were granted access to China and established residence there. Motivated by clinical necessities and the inquisitiveness of the Western scientific community, these missionaries meticulously documented the medicinal resources available in China, endeavoring to incorporate this knowledge into Western pharmacology. Among the various reports produced in multiple languages, the contributions in English have emerged as particularly influential. This article seeks to analyze the (...) information-gathering processes within the missionary network and among other naturalists, commencing with Robert Morrison, the inaugural compiler of the English-Chinese dictionary, and extending to Stephen A. Hunter, who collaborated with Chinese officials to develop a complete translation for pharmaceutical nomenclature. (shrink)

Georgia State University College of Law, through the Center for Law, Health & Society, developed a pair of online libraries for faculty teaching public health law in schools of law or public health. Development of these libraries was funded by a grant from the Robert Wood Johnson Foundation as part of The Future of Public Health Law Education: Faculty Fellowship Program. This article describes the goals of the program addressed by the libraries, the development process, the resources included, and how (...) faculty may benefit from the materials and provide materials benefitting other faculty across the country. (shrink)

The article examines the role of discourse in organisational sensemaking. By building links between the theorising undertaken within organisational studies and the empirical analysis of multimodal social interaction, it argues for a relational view of sensemaking and investigates how sense is made in and through social interaction in real organisational situations where language use intertwines with embodied actions and the manipulation of artefacts. In particular, the article studies the use of discourse technologies of textual artefacts in sensemaking processes. The data (...) come from training workshops of a Finnish workplace organisation, conducted in order for the employees to delineate the history and future of their organisation with the help of writable papers. The results show how the papers exert agency in the situation by facilitating three specific discursive practices and by enabling and restricting the actions employed in constructing a shared understanding of the organisational reality. (shrink)

For nearly as long as the topic of sustainable business has been taught and researched in business schools, proponents have warned about barriers to genuine integration in business school practices. This article examines how academic sustainability centres try to overcome barriers to integration by achieving technical, cultural and political fit with their environment :67–92; Ansari et al., Academy of Management Review 35:67–92, 2010). Based on survey and interview data, we theorise that technical, cultural and political fit are intricately related, and (...) that these interrelations involve legitimacy, resources and collaboration effects. Our findings about sustainability centres offer novel insights on integrating sustainable business education given the interrelated nature of different types of fit and misfit. We further contribute to the literature on fit by highlighting that incompatibility between strategies to achieve different types of fit may act as a source of dynamism. (shrink)

In a carefully argued article, Haley K. Sullivan and Benjamin E. Berkman address the important question of whether investigators have a duty to report incidental findings to research participants in low‐resource settings. They suggest that the duty to rescue offers the most plausible justification for the duty to return incidental findings, and they explore the implications of this duty for the context of research in low‐resource settings. While I think they make valuable headway on an important problem, in (...) this commentary, I identify a significant difference between the paradigmatic rescue case and the return of incidental findings in low‐resource settings. This difference, I suggest, implies that their framework may be too narrow in scope. If investigators (and their sponsors) really wish to fulfill their duty to rescue, they must consider factors that are left out of Sullivan and Berkman's framework. (shrink)

This book will be a down-to-earth text that is centred on empirical evidence of common ethical dilemmas in pharmacy. It will be clear and practical, in keeping with the pragmatism of many pharmacists. It will explain relevant theoretical aspects of ethics and decision-making, to enhance professional knowledge and skills. It is the first book to be specifically dedicated to pharmacy ethics and decision-making, as at the moment, the only resources are texts in medical or nursing ethics more broadly. This book (...) will clearly explain how to apply ethical reasoning and holistic decision-making in everyday pharmacy practice, and it will be useful for all pharmacy undergraduates, postgraduates, and professionals. (shrink)

Research on how genetics contribute to human behavior and achievement raises many bioethical questions. What are we to make, for example, of a study published last year that found that students with genetic variants associated with educational attainment (years of education) took more advanced math classes in ninth grade? Does this finding have implications for education practice? Should it? How so? Questions like these serve as reminders that genetic science has long been misused to draw conclusions about individuals and groups (...) of people, conclusions laced with racism and other biases. As research on human genomics ramps up, now is the time to ramp up science communication about what these studies do and, importantly, do not show. A new feature on The Hastings Center's website does just that. (shrink)

People should be at the centre of attention within knowledge-based economics. The leaders of each enterprise ought to focus on providing the best conditions for their employees’ professional and individual development and treat them with respect in terms of their dignity and needs. In contemporary literature two notions in perceiving people in organisations are noticeable. The first one treats employees as ‘resources’ which have to be properly used or as ‘capital’ that should bring a decent return on investment. The (...) second notion derives a lot from Christian philosophy and sees the human as a person who treats work as a way to realize his calling and thus is able to take responsibility for the decisions made and actions taken. Acting in a constantly changing environment, people have to be flexible and able to take advantage of emerging opportunities and avoid threats. Within this process it is not a matter of being a human ‘being’ but rather becoming, which means that they are incessantly developing their potential. Although it is hard to predict human behaviour, the main task for managers is to lead in a way that will help employees use their full potential for both their own and the company’s benefit. (shrink)

I had heard rumblings of the possibility of consult on this patient. As a pediatric intensivist conducting consults for my institution's clinical bioethics service, I had come to appreciate that many low‐ to moderate‐level ethical dilemmas are present in the pediatric intensive care unit (PICU) every single day. Despite this, or maybe because of it, it takes quite a morally complicated situation to trigger a consult for the service.Sam was a three‐month‐old who had been born full‐term without complications. In the (...) weeks prior to admission, his parents found that he was not feeding well and at times struggled to catch his breath. At our institution's PICU, it was determined that his decline was secondary to dilated cardiomyopathy, for which he would require cardiac transplantation for survival. Sam's parents were unsure if putting him through a heart transplant was the right thing to do, but they were unable to tolerate the thought of losing him. After an extensive consent process, they decided to pursue cardiac transplantation. (shrink)

Aim: To explore healthcare chaplains’ experience of providing spiritual support to individuals and families from minority religious and non-religious faiths and to identify key elements of the role. Background: Currently, there is limited research uncovering the essential elements of healthcare chaplaincy, specifically with reference to religious and/or spiritual diversity, and as interprofessional collaborators with nurses and midwives in healthcare. Research design and participants: Using phenomenology, we interviewed eight healthcare chaplains from a variety of healthcare settings in the Republic of Ireland. (...) Data were analysed using a seven-step framework comprising Moustakas’ (1994) modification of the Van Kaam method of data analysis. Ethical considerations: Ethical approval was granted by the university and the principles of informed consent applied. Findings: Three main themes emerged: what the chaplain brings; components of ritual, minority faith or no faith; and practising chaplaincy. Subthemes included ‘offering’, ‘awareness and insight’, ‘acceptance and empathy’, ‘skilled companionship’, ‘presence’, ‘a confidant and holder of hope’ and ‘a vital resource’. Discussion and conclusions: The healthcare chaplain is a key collaborator in facilitating holistic person-centred care and in supporting healthcare professionals. Chaplaincy services are an essential but largely unrecognised and potentially cost-effective component of interprofessional team working. Relevance to clinical practice: This study has illuminated key aspects of the healthcare chaplain’s role as interprofessional collaborator in person-centred care, in navigating diversity and ensuring respect and dignity for the person irrespective of religious or spiritual care needs. (shrink)

The fair distribution of health resources is critical to health justice. But distributing healthcare equitably requires careful attention to the existing distribution of other resources, and the economic system which produces these inequalities. Health is strongly determined by socioeconomic factors, such as the effects of racism on the health of communities of colour, as well as the broader market-oriented healthcare and pharmaceutical systems that put the pursuit of profit above the alleviation of suffering. Two papers in this issue confront health (...) injustices at different scales, and make far-reaching recommendations for more just healthcare allocation policies. Orphan drugs are those that pharmaceutical companies are unwilling to develop unless they are offered financial incentives to do so. When a target patient group is very small, or very poor, producing drugs is unprofitable. If patients are to benefit from these drugs in a marketised pharmaceutical regime, governments must step in to provide incentives for research and development. Yet government spending ought to prioritise value for money, and is generally guided by a utilitarian framework. In the case of neglected tropical diseases, there is no moral conflict: large numbers of people would benefit greatly from these treatments. However, there are practical limitations: the governments of affected populations are often unable to fund incentives for research and development, and solidarity from elsewhere is limited.1 2 In the case of rare diseases, Global North governments usually can afford to incentivise the development of treatments to serve their populations, but given the small numbers of beneficiaries, doing so seems a questionable use of resources. Many Global North governments make an exception to the general utilitarian heuristic to accommodate the moral intuition that the claims of a person with a rare …. (shrink)

In response to the increasing interest in the cultural and historical interactions between the Mediterranean and Asia, Jesuit University Ignatianum in Cracow has established a Centre for Mediterranean and Oriental Studies. Over the centuries, the historical and cultural connections between the Mediterranean and Asian regions have been marked by a rich tapestry of interactions. These exchanges encompassed not only commercial activities but also religious, technological, and cultural aspects. Understanding these complex relationships is essential, particularly for defining the conditions for (...) future international cooperation. China, Korea, and Japan now play significant roles on the international stage. The Western world first encountered these societies at the dawn of the modern era. In the early phase of this contact, interactions primarily involved exchanges of ideas, with Jesuit missionaries playing a pivotal role. In the second half of the 19th century, cultural interactions were further influenced by political and economic factors, leading to partial Westernization of these societies. In the past three decades, tensions between Chinese and Western civilizations have emerged, largely driven by political and economic rivalries. These tensions are compounded by a deep crisis within Western civilization itself, marked by a weakening social fabric and diminishing sense of identity. This crisis is closely related to modern generations’ departure from Christian religion and Greco-Roman traditions, which historically bonded Western civilization. Cultural historians at Ignatianum have highlighted that Jesuit missionaries active in Northeast Asia during the 16th and 17th centuries—such as Poles Michał Boym, Jan Mikołaj Smogulecki, and Andrzej Rudomina— left behind a valuable archive of early contacts between Mediterranean civilization and the Asian world. A team of researchers at Ignatianum is currently examining these materials as part of grant projects under the Science for Society and National Science Development Program. (shrink)

“Virtue jurisprudence” is a normative and explanatory theory of law that utilises the resources of virtue ethics to answer the central questions of legal theory. The main focus of this essay is the development of a virtue–centred theory of judging. The exposition of the theory begins with exploration of defects in judicial character, such as corruption and incompetence. Next, an account of judicial virtue is introduced. This includes judicial wisdom, a form of phronesis, or sound practical judgement. A virtue–centred account (...) of justice is defended against the argument that theories of fairness are prior to theories of justice. The centrality of virtue as a character trait can be drawn out by analysing the virtue of justice into constituent elements. These include judicial impartiality (even–handed sympathy for those affected by adjudication) and judicial integrity (respect for the law and concern for its coherence). The essay argues that a virtue–centred theory accounts for the role that virtuous practical judgement plays in the application of rules to particular fact situations. Moreover, it contends that a virtue–centred theory of judging can best account for the phenomenon of lawful judicial disagreement. Finally, a virtue–centred approach best accounts for the practice of equity, departure from the rules based on the judge’s appreciation of the particular characteristics of individual fact situations. [ABSTRACT FROM AUTHOR]. (shrink)

In 1882, the South Australian Baptist Missionary Society sent off its first missionaries to Faridpur in East Bengal. Miss Marie Gilbert and Miss Ellen Arnold were the first of a stream of missionary women who left the young South Australian colony to work in India. Scores of women from other Christian denominations and from other Australian colonies also went to India and indeed to other mission fields in the nineteenth and twentieth centuries. As with other western women missionaries, (...) these women intended to save souls and to bring India's daughters to Christ, often by means of medical work. But unlike their British sisters, these women came from the edge of empire to intervene in another, but different, colonial site. These missionary ventures coincided with efforts of the Australian settlers to elaborate for themselves an identity separate from and against that of the metropolitan centre. Within these debates, contestations over the meaning of ‘the colonial girl’ and ‘the Australian girl’ played a key role. The article explores why the women were drawn to India rather than to working with Aboriginal people in Australia. It begins to investigate how in seeking to reconstruct Indian womanhood they elaborated for themselves a separate colonial, Australian identity and how much in their missionary endeavours they affirmed an identity as white, Christian and ultimately British. (shrink)

From a speech given at a conference sponsored by the Electronic Funds Transfer Association (EFTA) on "The Puzzle of Data Security and Consumer Privacy," Washington, DC, 16 November 1992. At that time, Dr. Perry was a Consultant in Advisory Services for the Ethics Resource Center.

Clinical Ethics, Ahead of Print. It could hardly be denied that healthcare should be patient-centred. However, some of the practices commonly described as patient-centred care may have ethically problematic consequences. This article identifies and discusses twelve ethical conflicts that may arise in the application of person-centred care. The conflicts concern e.g. privacy, autonomous decision-making, safeguarding medical quality, and maintaining professional egalitarianism as well as equality in care. Awareness of these potential conflicts can be helpful in finding the best way to (...) ensure that healthcare has its focus on the needs and interests of the patients. Patient-centred care may have to take different forms, depending of the nature of the disease, the patient’s life situation, and the economic, organizational and technological resources available to the healthcare unit. (shrink)

The Australian government's response to the Millennium Drought (1997–2010) has been met with praise and contestation. While proponents saw the response as timely and crucial, critics claimed it was characterized by government overreach and mismanagement. Five months of field research in farm communities in the Murray Darling Basin (MDB) identified two dominant discourses: administrative rationalism and a local community-based discourse I have termed community-centrism. Administrative rationalism reflects the value of scientific inquiry in service to the state and is the dominant (...) research-based problem-solving model used by water and natural resource agencies (Dryzek in The politics of the earth: environmental discourses, Oxford University Press, 2013; Colloff and Pittock in Aust J Water Resour, 23(2):88–98, 2019). Community-centrism was identified through discussions with farmers and represents a bottom-up approach to environmental planning and management that seeks to incorporate local knowledge, planning, and direct participation. This investigation reveals how discourses define problems and policy choices. While market-based government interventions were likely necessary to address the crisis in the MDB, community-centred responses could have enhanced the government’s capacity to respond to problems. This paper argues that the long-term sustainability of water management in the Basin will require a reorientation on the part of farmers, academics, and governments to develop a community-centred approach to water policies impacting agriculture. (shrink)

This paper discusses a study examining how mentors in nurse education make professional judgments about the clinical competence of their pre‐registration nursing students. Interviews were undertaken with nine UK students and 15 mentors, using critical incidents in practice settings as a focus. The study was undertaken for the English National Practice‐Based Professional Learning Centre for Excellence in Teaching and Learning. This paper reports on the conversation analytic thread of the work. The mentor role with pre‐registration nursing students is not (...) only supportive but involves formal assessment. Central to the relationship is communication. In professional education, communication is seen as a skill to be applied and assessed in practice settings but is also the medium mentors and mentees use to talk about the relationship. Analysis of excerpts of conversation in the interviews shows that episodes of communication are used as topics of conversation to establish professional identity. It also reveals that judgments about the extent of professional capacity of both students and mentors are grounded in everyday behaviours (for example, enthusiasm, indifference and confidence) as well as professional competence. In addition to focusing on clinical issues, mentors can and do use mundane communication as a resource for judgments about competence. (shrink)

In an age of global capitalism, pandemics, far-flung biobanks, multinational drug trials and telemedicine it is impossible for bioethicists to ignore the global dimensions of their field. However, if they are to do good work on the issues that globalisation requires of them, they need theoretical resources that are up to the task. This paper identifies four distinct understandings of ‘globalised’ in the bioethics literature: a focus on global issues; an attempt to develop a universal ethical theory that can transcend (...) cultural differences; an awareness of how bioethics itself has expanded, with new centres and journals emerging in nearly every corner of the globe; a concern to avoid cultural imperialism in encounters with other societies. Each of these approaches to globalisation has some merit, as will be shown. The difficulty with them is that the standard theoretical tools on which they rely are not designed for cross-cultural ethical reflection. As a result, they leave important considerations hidden. A set of theoretical resources is proposed to deal with the moral puzzles of globalisation. Abandoning idealised moral theory, a normative framework is developed that is sensitive enough to account for differences without losing the broader context in which ethical issues arise. An empirically nourished, self-reflexive, socially inquisitive, politically critical and inclusive ethics allows bioethicists the flexibility they need to pick up on the morally relevant particulars of this situation here without losing sight of the broader cultural contexts in which it all takes place. (shrink)

The “centre-periphery” relationship historically structured scientific exchanges between metropolis and province, between the fount of empire and its outposts. But the exchange, if regarded merely as a one-way flow of scientific information, ignores both the politics of knowledge and the nature of its appropriation. Arguably, imperial structures do not entirely determine scientific practices and the exchange of knowledge. Several factors neutralise the over-determining influence of politics—and possibly also the normative values of science—on scientific practice.In examining these four examples of (...) Indian scientists in encounters with their peers at the centre, exceptional scientists are seen in a social context where the epistemology of science supposedly describes its practice. Imperialism imposes practices and patronage, which moderate the exchange of scientific knowledge. But, at Level Two, the politics of knowledge and the patterns of patronage within it mediate exchanges between the centre and the periphery.The first step in reconfiguring exchanges between centre and periphery —in this case, between Europe and India during the period 1850 to 1930— is to recognise the relation between the acquisition of resources and the maintenance of legitimacy and identity.67 Political life is not confined to the core of political institutions.68 Second, in examining science as practised in the colonies, it is necessary to see stages of scientific institutions, whose development structures the exchange.From the encounter of Ramchandra and De Morgan, it is evident that the centre-periphery framework should be separated from the models of transmission embedded within it. The notion of “translation” helps to suggest that scientists bring personal motives and meanings to each encounter. Ramchandra, for example, sought a novel method of teaching Indians calculus, while De Morgan's interest lay in finding a place for algebra in a liberal education.The hierarchy inherent in the centre-periphery framework compels the conclusion that, at Level Two, the autodidact outside the institutions of science must have his work presented to scientists at the centre by authoritative figures from the centre. This is not mainly a question of imperialism, but rather of patronage. The peripheral scientist could not be granted direct entry into the collegial circle until his efforts at the periphery could be translated into the language and concerns of the central community. Ramanujan's enigmatic formulas were translated into the language of analysis by Hardy, which enabled the creation of a field to which Hardy was committed. Scientists from the periphery who were already part of the circle by virtue of their training, were not necessarily subject to the same degree of attestation as other scientists from the periphery. P.C. Ray, with his DSc from Edinburgh, and his position at Calcutta University, had less difficulty in winning the trust of colleagues at the centre, even when he returned to India. On the contrary, remaining at the periphery, he moved from a context of patronage to a sphere of competition. In addition, Ray's collegiality, even at Level Two, was more comprehensive, and connected him with Level One.Eventually, the professional Indian science graduate found collegiality within the international community of scientists. Saha's self-imposed progressive nationalism constrained his identification with the centre and made him a potential competitor instead. Once having achieved eminence in the world of science, C.V. Raman and Saha shifted their work to journals of physics published in India in order to further the cause of physics research in their own country.69To go beyond the limitations of the centre-periphery model, it is necessary not merely to examine exchanges between scientists functioning in a “shared epistemological universe”,70 but also to recognise the part played by institutions, the experience of colonialism, and the forms of patronage characterising both colonialism and science. Put another way, although there is relative epistemological autonomy within the disciplinary research communities of science, the interplay between knowledge and power structures this exchange.The scientific links between colonial India and Britain at the turn of the century were mediated by structures which prefigured change. Does structure determine all? If it does, we are left with an Orientalist reconstruction of the docile native, and a passive cultural medium into which science percolates. But this neglects the role of scientists in creating new structures within which they worked. A middle position—one more sensitive to the exigencies of colonial scientific life—would be one where the participants are seen not as the dupes of “structure nor the potentates of action”, but as occupying a ground between the two.71. (shrink)

Context: A central motivation behind various embodied, extended, and enactive (4E) approaches to cognition is to ground our understanding of minds and cognition within the biological structures that give rise to life. Because of this, their advocates often claim a natural kinship with dynamical and developmental systems theories. However, these accounts also explicitly or implicitly privilege individual organisms in ways that contrast with many of the insights of systems and developmental systems approaches to biology. Problem: The prioritization of individual organisms (...) within 4E approaches to cognition contrasts with the default entangled structure of biological systems associated with cognitive agency. We provide means for 4E cognitive science to move beyond an individual-centred view of cognitive agency. Method: We first identify and problematize individual-centredness within various predominant 4E approaches by comparison with biological research and developmental systems theory. Subsequently, we offer conceptual resources from the field of ecological research for understanding cognitive agency beyond the predominant focus on individual organisms. Results: Cognitive agency may be understood without privileging individual organisms by reading nonequilibrium maintenance in terms of a dynamic differentiation instead of individual organismic autonomy. This form of organizational structure corresponds to the notion of sympoiesis from ecological research. Implications: Approaching cognitive agency without privileging individual organisms should be invaluable to advocates of 4E cognition seeking to ground notions of cognition and mind within contemporary biological research. Constructivist content: We seek to expand upon existing constructivist perspectives on the organizing principles of cognitive agency, such as sensorimotor embodiment and autopoiesis, arguing that meta-organismic cognitive agents (including humans) embody distributed relations beyond the privileging of individual organisms. Key words: 4E cognition, autopoiesis, cognitive agency, developmental systems theory, enactivism, extended mind thesis, holobionts, sympoeisis. (shrink)