Background: Informed consent is fundamental to the autonomous decision-making of patients, yet much is still unknown about the process in the clinical setting. In an evolving healthcare landscape, nurses must be prepared to address patient understanding and participate in the informed consent process to better fulfill their well-established role as patient advocates. Research objective: This study examines hospital-based nurses’ experiences and understandings of the informed consent process. Research design: This qualitative descriptive study utilized a semi-structured interview approach identifying thematic concerns, (...) experiences, and knowledge of informed consent across a selected population of clinically practicing nurses. Participants and research context: In all, 20 baccalaureate prepared registered nurses practicing in various clinical settings (i.e. critical care, oncology, medical/surgical) at a large northeastern academic medical center in the United States completed semi-structured interviews and a demographic survey. The mean age of participants was 36.6 years old, with a mean of 12.2 years of clinical experience. Ethical considerations: Participation in this study involved minimal risk and no invasive measures. This study received Institutional Review Board approval from the University of Pennsylvania. All participants voluntarily consented. Findings: The majority of participants (N = 19) believe patient safety is directly linked to patient comprehension of the informed consent process. However, when asked if nurses have a defined role in the informed consent process, nearly half did not agree (N = 9). Through this qualitative approach, three major nursing roles emerged: the nurse as a communicator, the nurse as an advocate, and the clerical role of the nurse. Discussion and conclusion: This investigation contributes to the foundation of ethical research that will better prepare nurses for patient engagement, advance current understanding of informed consent, and allow for future development of solutions. Nurses are at the forefront of patient–provider interactions and they are often presented opportunities to learn about and engage in the informed consent process. (shrink)

Background Diversity in Institutional Review Board (IRB) membership is important for both intrinsic and instrumental reasons, including fairness, promoting trust, improving decision quality, and responding to systemic racism. Yet U.S. IRBs remain racially and ethnically homogeneous, even as gender diversity has improved. Little is known about IRB chairpersons’ perspectives on membership diversity and barriers to increasing it, as well as current institutional efforts to promote diversity, equity, and inclusion (DEI) within IRB membership.Methods We surveyed IRB chairpersons leading U.S. boards registered (...) with the Office for Human Research Protections. Here, we focus exclusively on responses from a subset of 388 chairpersons of IRBs at universities and academic medical centers (AMCs).Results Board chairs were predominantly white and evenly split between men and women. Only about half reported that their boards had at least one member who is Black or African American (51%), Asian (56%), or Hispanic (48%), with 85% of university/AMC boards comprised entirely (15%) or mostly (70%) of white members. Most IRB chairpersons (64%) reported satisfaction with the current diversity of their membership. Participants largely agreed that considering diversity in the selection of IRB members is important (91%), including to improve the quality of IRB deliberation (80%), with an emphasis on racial/ethnic (85%) and gender diversity (74%). Most participants (80%) reported some type of active DEI effort regarding board membership at their university/AMC and just over half (57%) expressed satisfaction with these efforts.Conclusions Our national survey found that although university/AMC IRB chairpersons report valuing diversity in board membership, it may be lacking in key areas. Going forward, it will be important to specify clear reasons for diversity in the IRB context, as well to establish targets for acceptable levels of board diversity and to match DEI efforts to those targets. (shrink)

BackgroundFollowing the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics—one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this (...) framework from young people’s perspectives, informed by advances in childhood ethics and children’s rights.Main bodyIn this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted—aligned with the approach used by Thompson and colleagues—to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health.ConclusionEfforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts. (shrink)

Dr Sydney Brenner has played a major, and unique, role in biology during the past 40 years. His contributions have ranged from key work on the structure of the genetic code and the existence of mRNA through the development of Caenorhabditis elegans as a key model system in developmental biology to genomic analysis and function in vertebrates. BioEssays went to interview Dr Brenner at his home in the cathedral city of Ely, England, on the significance of the genome projects (...) for human biology, in particular, and for biology, in general. (shrink)

A major objection to the view that the relation of persons to human animals is coincidence rather than identity is that on this view the human animal will share the coincident person's physical properties, and so should (contrary to the view) share its mental properties. But while the same physical predicates are true of the person and the human animal, the difference in the persistence conditions of these entities implies that there will be a difference in the properties ascribed by (...) these predicates, with the result that the physical properties that determine the person's mental states will belong to the person and not to the human animal. (shrink)

Background Inadequate knowledge among health care providers (HCPs) and parents of affected children limits the understanding and utility of secondary genetic findings (SFs) in under-represented populations in genomics research. SFs arise from deep DNA sequencing done for research or diagnostic purposes and may burden patients and their families despite their potential health importance. This study aims to evaluate the perspective of both groups regarding SFs and their choices in the return of results from genetic testing in the context of orofacial (...) clefts.Methods Using an online survey, we evaluated the experiences of 252 HCPs and 197 parents across participating cleft clinics in Ghana and Nigeria toward the return of SFs across several domains.Results Only 1.6% of the HCPs felt they had an expert understanding of when and how to incorporate genomic medicine into practice, while 50.0% agreed that all SFs should be returned to patients. About 95.4% of parents were willing to receive all the information from genetic testing (including SFs), while the majority cited physicians as their primary information source (64%).Conclusions Overall, parents and providers were aware that genetic testing could help in the clinical management of diseases. However, they cited a lack of knowledge about genomic medicine, uncertain clinical utility, and lack of available learning resources as barriers. The knowledge gained from this study will assist with developing guidelines and policies to guide providers on the return of SFs in sub-Saharan Africa and across the continent. (shrink)

Ph.D. Thesis. University of Hawaiʻi at Mānoa 2018.

Sydney Shoemaker is one of the most influential philosophers currently writing on philosophy of mind and metaphysics. The essays in this collection deal with the way in which we know our own minds, and with the nature of those mental states of which we have our most direct conscious awareness. Professor Shoemaker opposes the 'inner sense' conception of introspective self-knowledge. He defends the view that perceptual and sensory states have non-representational features - 'qualia' - that determine what it is (...) like to have them. Amongst the other topics covered are the unity of consciousness, and the idea that the 'first-person perspective' gives a privileged route to philosophical understanding of the nature of mind. This major collection is sure to prove invaluable to all advanced students of the philosophy of mind and cognitive science. (shrink)

In Physical Realization, Sydney Shoemaker considers the question of how physicalism can be true: how can all facts about the world, including mental ones, be constituted by facts about the distribution in the world of physical properties? Physicalism requires that the mental properties of a person are 'realized in' the physical properties of that person, and that all instantiations of properties in macroscopic objects are realized in microphysical states of affairs. Shoemaker offers an account of both these sorts of (...) realization, one which allows the realized properties to be causally efficacious. He also explores the implications of this account for a wide range of metaphysical issues, including the nature of persistence through time, the problem of material constitution, the possibility of emergent properties, and the nature of phenomenal consciousness. (shrink)

The words “content” and “character” in my title refer to the representational content and phenomenal character of color experiences. So my topic concerns the nature of our experience of color. But I will, of course, be talking about colors as well as color experience. Let me set the stage by mentioning some things, some more controversial than others, that I will be taking for granted. I assume, to begin with, that objects in the world have colors, and have them independently (...) of being perceived to have them, and independently even of there being creatures capable of perceiving them. I think, and this of course sets me apart from the many color irrealists among philosophers and color scientists, that any reasonable semantics for color terms, and any reasonable account of the reference of color concepts, should yield the result that colors are properties of external things that are realized in certain of their physical properties, namely those responsible for their reflecting or emitting the light whose impact on our retinas is involved in causing our color perceptions. This brings me to a further assumption that I shall be making, namely the truth of physicalism. I take physicalism to be the thesis that all properties of things either are or are realized in basic physical properties, where basic physical properties are the properties that underlie the behavior and causal powers of inanimate things. There are two ways in which the commitment to physicalism will figure in my discussion. First, I assume that colors are physically realized properties. Second, I assume that color experiences are physically realized. These two commitments frame the problem I am discussing – how can colors be properties realized in the microphysical properties of things, and how can color experience be so realized? I don’t think there is any generally accepted account of what it is for a property to be “realized in” other properties. For those who think, as I do, that properties are individuated by their causal features, it should seem plausible to say that property P realizes property Q just in case the forward looking causal features of Q are a subset of the forward looking causal features of P, and the backward looking.... (shrink)

[Sydney Shoemaker] A major objection to the view that the relation of persons to human animals is coincidence rather than identity is that on this view the human animal will share the coincident person's physical properties, and so should (contrary to the view) share its mental properties. But while the same physical predicates are true of the person and the human animal, the difference in the persistence conditions of these entities implies that there will be a difference in the (...) properties ascribed by these predicates, with the result that the physical properties that determine the person's mental states will belong to the person and not to the human animal. /// [Galen Strawson] What are the grounds of self-consciousness? I consider 29 proposals and reject 22, including a number of proposals that experience of body (or bodies) is necessary for self-consciousness. A popular strategy in debates of this sort is to argue that one cannot be said to have some concept C (e.g. the concept ONESELF, necessary for self-consciousness) unless one has a need or a use for C given the character of one's experience considered independently of the character that it has given that one possesses C. I suggest that such arguments are invalid. (shrink)

During the later years of his life, the late Professor Alexander devoted much of his time to the study of our aesthetic and moral experience. In regard to the latter, Alexander was impressed by Adam Smith's treatment of the Moral Sentiments and especially with what he considered his sure insight in seeking for the ground of obligation in the causes of conduct, rather than in its effects. These causes were the passions. In this he was in sympathy with his contemporary (...) Hobhouse, who asserted with conviction that action rested on impulse feeling, and that it was useless to look for anything whether it was called Practical Reason or anything else, that stood outside the body of impulse feeling and controlled it. I think it was the considered opinion of Alexander, as it was that of Hobhouse, that if Psychology had anything to teach us bearing upon Morals, it was that the springs of human conduct must be looked for in our inherited tendencies with their associated emotions. Fear, sorrow, joy, repulsion, curiosity, pugnacity, self-assertion, the sex instinct, and acquisitiveness and constructiveness, are present, not only in men of all living races, but also in most of the higher animals. These specific tendencies and emotions, with certain complex passions such as admiration, reverence, scorn and the rest; together with one or two general tendencies such as sympathy and imitativeness, arising out of the nature of mental processes, must have played a leading role in the determination of human conduct, both in its lower and higher grades. (shrink)

Since the appearance of a widely influential book, Self-Knowledge and Self-ldentity, Sydney Shoemaker has continued to work on a series of interrelated issues in the philosophy of mind and metaphysics. This volume contains a collection of the most important essays he has published since then. The topics that he deals with here include, among others, the nature of personal and other forms of identity, the relation of time to change, the nature of properties and causality and the relation between (...) the two, dualism and immortality, and the nature of mental states. All the essays show the same care and precision in argument as the earlier book, but they also reveal a substantial shift in Professor Shoemaker's position to a form of materialism. In fact, a number of papers together constitute what is probably the most subtle and rigourous defence yet of a sophisticated functionalism in the account of the mind. (shrink)

Today’s scholarship has paid little attention to the work of St. Augustine titled De Haeresibus ad Quodvultdeum. The following article will discuss the work itself in a couple of ways, first, by deciphering the sources used by Augustine and his definition of heresy; secondly, by categorizing the heresies in a way that is both understandable to the modern mind and consistent with current Catholic terminology, so that the language of the current century can be employed to describe and categorize heresies (...) from the fifth century. (shrink)

Despite the importance of Suárez’s defense of the freedom of the will at the threshold of early modern philosophy, his account has received scant recent attention. This paper aims partially to redress that neglect. Suárez’s position can be understood as a balancing act between desiring to attribute libertarian freedom to agents and desiring to maintain the will’s status as a rational appetite. Hence, he rejects an intellectualism that says that choices are necessitated by the intellect’s judgements (since he does not (...) think that the judgements themselves can be directly free), but affirms that only what is judged good can be chosen. (shrink)

Adultcentrism is an inherent feature of the social fabrics comprising most resource-rich countries in the twenty-first century that undermines the capacities, value, and voices of young people in various ways. In the context of COVID-19, we are confronted with the question of whose voice matters and must ask: is adultcentrism ethically permissible during a pandemic? This Critical Controversy examines this question in relation to evolving concepts of childhood, children’s rights, and the capacities of young people, to highlight areas of tension, (...) future research, and potential for critical dialogue. (shrink)

In this essay, I discuss a potential nexus for comparison between Hawaiian and Chinese philosophies grounded in what I call “terrestrial identity”. I bring Fei Xiaotong’s description of the formation of social identity in China, which is historically agrarian and inalienably place-based, to meet contemporary Hawaiian philosophical perspectives of personal responsibility, genealogical consciousness, and “seascape epistemology” to flesh out a new theory of relationality, one that includes the ontological, historical, and ethical relationship of humans to the land on which they (...) orient themselves and that defines the circumstances of their lives. The concept of terrestrial identity is inclusive in terms of types of relational entities, accommodating place, space, and memory into a comprehensive social ontology. It also opens onto discussions of contemporary social problems in a way that centres place and contextuality. I will conclude this essay with such a discussion, regarding homelessness among Kānaka Maoli. (shrink)

Tyler Burge argues on the basis of an account of memory that the notion of quasimemory cannot be used to answer the circularity objection to psychological accounts of personal identity. His account implies the impossibility of the "Parfit people," creatures psychologically like us who undergo amoeba-like fission at the age of twenty-one, with only one offshoot allowed to survive, and who have "quareers," made up of the career of the original person and the career of the sole survivor, that exhibit (...) the same sort of psychological continuity that characterizes normal human careers, and are such that epistemic warrant is preserved across the episodes of fission and often involves quasimemories that are not memories. But what he says about memory does not support the denial that such creatures are possible. Where he thinks de se attitudes are necessary, de se * attitudes, indexed to quareers instead of to careers, would serve equally well. It is further argued that the circularity objection to psychological accounts can be answered without appeal to the notion of quasi-memory. Because of the internal relations between the causal profiles of mental states and the persistence conditions of their possessors, in principle there can be a "package deal" definition that simultaneously defines both. (shrink)

From now on I will assume that it is possible in principle for there to be cases of spectrum inversion in which the invertees are equally good perceivers of the colors. What I want to show next is that while allowing this possibility is incompatible with standard representationalism, it requires acceptance of a different version of representationalism. Consider the standard way of describing a case of spectrum inversion. Returning to Jack and Jill, we say that red things look to Jack (...) the way green things look to Jill, blue things look to Jack the way yellow things look to Jill, and so on. Of course, we might also express this by saying that the phenomenal character of Jack’s experience of red things is like the phenomenal character of Jill’s experience of green things, and so on. Or by saying that “what it is like” for Jack to see red things is “what it is like” for Jill to see green things, and so on. But “phenomenal character” is philosophical jargon, and “what it is like” is on its way to being that. We need to be able cash these locutions in terms that we are sure we understand. And I think that the best way of doing that is in terms of how things look. Now the sense in which red things look different to Jack and Jill cannot be that they look to have different colors in the epistemic sense. We can suppose that both perceive red things as being red, and therefore that to both red things look red in the epistemic sense. Nor can it be the comparative sense – to each, we can suppose, red things look like standard red things under standard conditions. The remaining sense of “looks” is supposed to be the phenomenal sense. Now those who employ this notion typically speak of things as looking red, blue, yellow, etc., in the phenomenal sense. But if Jack and Jill are both accurate perceivers of the colors of things, it can’t be that the difference in how things look to them is a difference in what colors things look to them, even if “looks” is used in the phenomenal sense.. (shrink)

Let thin properties be properties shared by coincident entities, e.g., a person and her body, and thick properties ones that are not shared. Thick properties entail sortal properties, e.g., being a person, and the associated persistence conditions. On the first account of realization defined here, the realized property and its realizers will belong to the same individual. This restricts the physical realizers of mental properties, which are thick, to thick physical properties. We also need a sense in which mental properties (...) can be realized in thin physical properties shared by a person and her body. Defining this in turn requires defining a sense in which the instantiations of sortal properties and of thick properties are realized in micro‐structural states of affairs. A fourth notion of realization is needed to allow for the possibility of coincident entities that share a sortal property, e.g., coincident persons. (shrink)

This paper aims to address when the wise person should participate in politics. The question is addressed through engagement with the Analects. Rather than provide interpretations of key terms in the Analects, we provide an account of wisdom that draws from themes in the Analects. The case is made that the wise person is committed to participating in politics primarily because of the connection between wisdom and benevolence (ren 仁 in the Analects). We address challenges to the Confucian approach from (...) the Zhuangzi concerning the potential harms of political participation. General political disengagement is not considered exemplary on the Confucian approach to wisdom, although when political engagement may be eschewed is explored. Finally, the case is made that while ren motivates the wise to participate politically, the wise also have a sense of timeliness that provides guidance as to when to refrain or withdraw from political participation. (shrink)

The paper is concerned with how neo-Lockean accounts of personal identity should respond to the challenge of animalist accounts. Neo-Lockean accounts that hold that persons can change bodies via brain transplants or cerebrum transplants are committed to the prima facie counterintuitive denial that a person is an (biologically individuated) animal. This counterintuitiveness can be defused by holding that a person is biological animal (on neo-Lockean views) if the “is” is the “is” of constitution rather than the “is” of identity, and (...) that a person is identical with an animal in a sense of “animal” different from that which requires the persistence conditions of animals to be biological. Another challenge is the “too many minds problem”: if persons and their coincident biological animals share the same physical properties, and mental properties supervene on physical properties, the biological animal will share the mental properties of the person, and so should itself be a person. The response to this invokes a distinction between “thin” properties, which are shared by coincident entities, and “thick” properties which are not so shared. Mental properties, and their physical realizers, are thick, not thin, so are not properties persons share with their bodies or biological animals. The paper rebuts the objection that neo-Lockean accounts cannot explain how persons can have physical properties. To meet a further problem it is argued that the biological properties of persons and those of biological animals are different because of differences in their causal profiles. (shrink)

Emergence requires that the ultimate physical micro-entities have “micro-latent” causal powers, which manifest themselves only when the entities are combined in ways that are “emergence-engendering,” in addition to the “micro-manifest” powers that account for their behavior in other circumstances. Subjects of emergent properties will have emergent micro-structural properties, specified partly in terms of these micro-latent powers, each of which will be determined by a micro-structural property specified only in terms of the micro-manifest powers of the constituents and the way they (...) are related. If the determiner and the determined properties are distinct, this determination is the basis of the supervenience of emergent properties on non-emergent physical properties. If not, emergence does not involve such supervenience. Either way, there is no problem with diachronic downward causation. (shrink)

EBM, and the hierarchy of evidence it prescribes, is a controversial model when it comes to research into the effectiveness of psychotherapeutic treatments. This is due in part to the so-called ‘Dodo Bird verdict’, which claims that all psychotherapies are equally effective, and that their effectiveness is largely due to the placebo effect. In response to this controversy, I argue that EBM can nevertheless be made to fit research into the effectiveness of psychotherapy, once a piecemeal approach to conducting RCTs (...) is taken. Such an approach involves studying the contributions made by individual treatment components. (shrink)

The sense in which having the available belief that P gives one a reason for believing that one believes that P is just that if one has that available belief one is thereby justified, or warranted, in believing that one has it. In explaining why it is so it helps to bring in the notion of rationality. We noted earlier that it is a requirement of full human rationality that one regularly revise one’s belief system in the direction of greater (...) consistency and coherence, and, as a condition of one’s being able to do this, that one have access to its contents and their relations to one another. Judging that one believes something when one does, and judging that one doesn’t believe something when one doesn’t, are manifestations of the satisfaction of this requirement of rationality. That seems a sufficient reason to say that one is warranted in doing so. (shrink)

Brain dead organ donors are the principal source of transplantable organs. However, it is controversial whether brain death is the same as biological death. Therefore, it is unclear whether organ removal in brain death is consistent with the ‘dead donor rule’, which states that organ removal must not cause death. Our aim was to evaluate the public9s opinion about organ removal if explicitly described as causing the death of a donor in irreversible apneic coma. We conducted a cross-sectional internet survey (...) of the American public (n=1096). Questionnaire domains included opinions about a hypothetical scenario of organ removal described as causing the death of a patient in irreversible coma, and items measuring willingness to donate organs after death. Some 71% of the sample agreed that it should be legal for patients to donate organs in the scenario described and 67% agreed that they would want to donate organs in a similar situation. Of the 85% of the sample who agreed that they were willing to donate organs after death, 76% agreed that they would donate in the scenario of irreversible coma with organ removal causing death. There appears to be public support for organ donation in a scenario explicitly described as violating the dead donor rule. Further, most but not all people who would agree to donate when organ removal is described as occurring after death would also agree to donate when organ removal is described as causing death in irreversible coma. (shrink)

Various theories of moral cognition posit that moral intuitions can be understood as the output of a computational process performed over structured mental representations of human action. We propose that action plan diagrams—“act trees”—can be a useful tool for theorists to succinctly and clearly present their hypotheses about the information contained in these representations. We then develop a methodology for using a series of linguistic probes to test the theories embodied in the act trees. In Study 1, we validate the (...) method by testing a specific hypothesis (diagrammed by act trees) about how subjects are representing two classic moral dilemmas and finding that the data support the hypothesis. In Studies 2–4, we explore possible explanations for discrete and surprising findings that our hypothesis did not predict. In Study 5, we apply the method to a less well‐studied case and show how new experiments generated by our method can be used to settle debates about how actions are mentally represented. In Study 6, we argue that our method captures the mental representation of human action better than an alternative approach. A brief conclusion suggests that act trees can be profitably used in various fields interested in complex representations of human action, including law, philosophy, psychology, linguistics, neuroscience, computer science, robotics, and artificial intelligence. (shrink)

Although Responsible Conduct of Research (RCR) training is common in the sciences, the effectiveness of RCR training is open to question. Three key factors appear to be particularly important in ensuring the effectiveness of ethics education programs: (1) educational efforts should be tied to day-to-day practices in the field, (2) educational efforts should provide strategies for working through the ethical problems people are likely to encounter in day-to-day practice, and (3) educational efforts should be embedded in a broader program of (...) on-going career development efforts. This article discusses a complex qualitative approach to RCR training development, based on a sensemaking model, which strives to address the afore-mentioned training concerns. Ethnographic observations and prior RCR training served the purpose of collecting information specific to a multi-disciplinary and multi-university research center with the goal of identifying metacognitive reasoning strategies that would facilitate ethical decision-making. The extensive qualitative analyses resulted in the identification of nine metacognitive reasoning strategies on which future RCR training will be developed. The implications of the findings for RCR training in the sciences are discussed. (shrink)

A common conception of what it is for one property to “realize” another suggests that it is the realizer property that does the causal work, and that the realized property is epiphenomenal. The same conception underlies George Bealer’s argument that functionalism leads to the absurd conclusion that what we take to be self-ascriptions of a mental state are really self-ascriptions of “first-order” properties that realize that state. This paper argues for a different concept of realization. A property realizes another if (...) its “forward looking” causal features are a subset of those of the property realized. The instantiation of the realizer property will include the instantiation of the property realized; and when the effects produced are due to the causal features of the latter, it is the instantiation of it that is appropriately regarded as their cause. Epiphenomenalism is avoided, and so is Bealer’s absurd conclusion. (shrink)