Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients’ well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA’s cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, west-coast (...) clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice. (shrink)

This research project defines the concept of an ethical incident pit and explores how qualitative and quantitative research into corporate ethical failurescan be conducted using this concept. Factors on an organizational, departmental and individual level are explored.

Although women are severely under-represented in national politics in Europe, in the European Parliament they are better represented than they are in the national parliaments of the EEC member states. This book examines why this is so. Based largely on their detailed interviews with women MEPs, the authors describe the latter's backgrounds, attitudes and political experience. They also explain the history, structure and organisation of the European Parliament and outline the complexities of the European legal system. A particular concern of (...) the book is the contribution that women MEPs have made to legislation and policy, expecially in the context of recent Community legislation on sex equality, and what impact their presence has had on issues relating to women's interests. (shrink)

Modified Theistic Activism is the view that abstract objects not essentially possessed by God fall under God’s creative activity in one way or another. Michelle Panchuk has argued that this position succumbs to the bootstrapping problem such that God is and is not logically prior to his properties—an incoherent and necessarily false state of affairs. In this essay we respond to Panchuk by arguing that our neo-Aristotelian account of substance and property possession successfully avoids the bootstrapping problem. Moreover, her own (...) neo-Augustinian account of universals contains many conceptual deficiencies and ultimately succumbs to an epistemic iteration of the bootstrapping problem. Finally, we argue that the reasons provided for thinking only created beings need universals to ground character is unmotivated. In clarifying and defending our position, our hope is to bury once and for all the familiar claim that traditional theists cannot be realists with respect to abstract objects because of divine bootstrapping. (shrink)

In this introduction to Part 1 of the Common Knowledge symposium, “Fuzzy Studies,” the journal's editor discusses four essays from the 1980s by Richard Rorty, in which Rorty chose to associate himself with various neopragmatists, Continental thinkers, and “left-wing Kuhnians” under the rubric of the “new fuzziness.” The term had been introduced as an insult by a philosopher of science with positivist leanings, but Rorty took it up as an “endearing” compliment, arguing that “to be less fuzzy” was also to (...) be “less genial, tolerant, open-minded, and fallibilist.” He defined the “new fuzziness” as “an attempt to blur just those distinctions between the objective and subjective and between fact and value which the critical conception of rationality has developed.” This introduction also examines W. V. Quine's essay “Speaking of Objects”, which describes objects as fuzzy “half-entities”; Clifford Geertz's essay “Blurred Genres”, which advises social scientists that being “taxonomically upstanding” is futile; and Lofti Zadeh's article “The Concept of a Linguistic Variable and Its Application to Approximate Reasoning”, which abandons “Aristotelian, bivalent logic” in favor of a “fuzzy logic” based on Zadeh's “fuzzy set theory.” This introductory piece relates these theoretical works of the past half-century to the sorites paradox and to classical issues of vagueness raised and still unresolved in Western philosophy. Returning then to Rorty, the author questions how Rorty expected his endorsement of the “new fuzziness” to be applied, as proposed, to theology and politics. Suggesting that such applications are the natural work of historians, the author, having asked the historian Natalie Zemon Davis for comment, then quotes her response—which associates fuzzy studies, “common knowledge,” and peacemaking—at length. (shrink)

The concept of a G‐quartet, a unique structural arrangement intrinsic to guanine‐rich DNA, was first introduced by Gellert and colleagues1 over 40 years ago. For decades, it has been uncertain whether the G‐quartet and the structure that it gives rise to, the G‐quadruplex, are purely in vitro phenomena. Nevertheless, the presence of signature G‐rich motifs in the eukaryotic genome, and the plethora of proteins that bind to, modify or resolve this nucleic acid structure in vitro have provided circumstantial evidence for (...) its physiological relevance. More recently, direct visualisation of G‐quadruplex DNA at native telomeres was achieved, bolstering the evidence for its existence in the cell. Furthermore, G‐quadruplex folded telomeric DNA has been found to perturb telomere function and to impede the action of telomerase, an enzyme overexpressed in >85% of human cancers, hence opening up a novel avenue for cancer therapy in the form of G‐quadruplex stabilising agents. BioEssays 29: 155–165, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

Recent magnetic resonance imaging and pathological studies have indicated that axonal loss is a major contributor to disease progression in multiple sclerosis. 1 H magnetic resonance spectroscopy, through measurement of N -acetyl aspartate, a neuronal marker, provides a unique tool to investigate this. Patients with primary progressive multiple sclerosis have few lesions on conventional MRI, suggesting that changes in normal appearing white matter, such as axonal loss, may be particularly relevant to disease progression in this group. To test this hypothesis (...) NAWM was studied with MRS, measuring the concentration of N -acetyl derived groups. Single-voxel MRS using a water-suppressed PRESS sequence was carried out in 24 patients with primary progressive multiple sclerosis and in 16 age-matched controls. Ratios of metabolite to creatine concentration were calculated in all subjects, and absolute concentrations were measured in 18 patients and all controls. NA/Cr was significantly lower in NAWM in patients than in controls, as was the absolute concentration of NA. There was no significant difference in the absolute concentration of creatine between the groups. This study supports the hypothesis that axonal loss occurs in NAWM in primary progressive multiple sclerosis and may well be a mechanism for disease progression in this group. (shrink)

Advances in genomics have led to calls for developing population-based preventive genomic sequencing programs with the goal of identifying genetic health risks in adults without known risk factors. One critical issue for minimizing the harms and maximizing the benefits of PGS is determining the kind and degree of control individuals should have over the generation, use, and handling of their genomic information. In this article we examine whether PGS programs should offer individuals the opportunity to selectively opt out of the (...) sequencing or analysis of specific genomic conditions or whether PGS should be implemented using an all-or-nothing panel approach. We conclude that any responsible scale-up of PGS will require a menu approach that may seem impractical to some, but that draws its justification from a rich mix of normative, legal, and practical considerations. (shrink)

Recent public hearings on misconduct charges belie the conjecture that due process will perforce defeat informed scientific reasoning. One notable case that reviewed an obtuse description of experimental methods displays some of the subtleties of differentiating carelessness from intent to deceive. There the decision of a studious nonscientist panel managed to reach sensible conclusions despite conflicting expert testimony. The significance of such a result may be to suggest that to curtail due process would be both objectionable and unproductive.

After introducing the new field of cultural evolution, we review a growing body of empirical evidence suggesting that culture shapes what people attend to, perceive and remember as well as how they think, feel and reason. Focusing on perception, spatial navigation, mentalizing, thinking styles, reasoning (epistemic norms) and language, we discuss not only important variation in these domains, but emphasize that most researchers (including philosophers) and research participants are psychologically peculiar within a global and historical context. This rising tide of (...) evidence recommends caution in relying on one’s intuitions or even in generalizing from reliable psychological findings to the species, Homo sapiens. Our evolutionary approach suggests that humans have evolved a suite of reliably developing cognitive abilities that adapt our minds, information-processing abilities and emotions ontogenetically to the diverse culturally-constructed worlds we confront. (shrink)

A simple experimental paradigm creates the powerful illusion that one is touching one’s own hand even when the two hands are separated by 15 cm. The participant uses her right hand to administer stimulation to a prosthetic hand while the Examiner provides identical stimulation to the participant’s receptive left hand. Change in felt position of the receptive hand toward the prosthetic hand has previously led to the interpretation that the participant experiences self-touch at the location of the prosthetic hand, and (...) experiences a sense of ownership of the prosthetic hand. Our results argue against this interpretation. We assessed change in felt position of the participant’s receptive hand but we also assessed change in felt position of the participant’s administering hand. Change in felt position of the administering hand was significantly greater than change in felt position of the receptive hand. Implications for theories of ownership are discussed. (shrink)

The generalized second law of thermodynamics states that entropy always increases when all event horizons are attributed with an entropy proportional to their area. We test the generalized second law by investigating the change in entropy when dust, radiation and black holes cross a cosmological event horizon. We generalize for flat, open and closed Friedmann–Robertson–Walker universes by using numerical calculations to determine the cosmological horizon evolution. In most cases, the loss of entropy from within the cosmological horizon is more than (...) balanced by an increase in cosmological event horizon entropy, maintaining the validity of the generalized second law of thermodynamics. However, an intriguing set of open universe models shows an apparent entropy decrease when black holes disappear over the cosmological event horizon. We anticipate that this apparent violation of the generalized second law will disappear when solutions are available for black holes embedded in arbitrary backgrounds. (shrink)

The neural representation of a repeated stimulus is the standard against which a deviant stimulus is measured in the brain, giving rise to the well-known mismatch response. It has been suggested that individuals with dyslexia have poor implicit memory for recently repeated stimuli, such as the train of standards in an oddball paradigm. Here, we examined how the neural representation of a standard emerges over repetitions, asking whether there is less sensitivity to repetition and/or less accrual of “standardness” over successive (...) repetitions in dyslexia. We recorded magnetoencephalography as adults with and without dyslexia were passively exposed to speech syllables in a roving-oddball design. We performed time-resolved multivariate decoding of the MEG sensor data to identify the neural signature of standard vs. deviant trials, independent of stimulus differences. This “multivariate mismatch” was equally robust and had a similar time course in the two groups. In both groups, standards generated by as few as two repetitions were distinct from deviants, indicating normal sensitivity to repetition in dyslexia. However, only in the control group did standards become increasingly different from deviants with repetition. These results suggest that many of the mechanisms that give rise to neural adaptation as well as mismatch responses are intact in dyslexia, with the possible exception of a putatively predictive mechanism that successively integrates recent sensory information into feedforward processing. (shrink)

The typical Cartesian collection contains papers which treat the problems arising out of Descartes's philosophy as though they and it appeared for the first time in a recent journal. The approach of this collection is quite different. The eight contributors concentrate on problems faced by Cartesianism which are of historical significance. Without denigrating the importance of the technique of exploiting the texts in a manner that appeals to contemporary philosophical interests, the contributors show how Cartesianism was shaped over time by (...) the criticism it received. This criticism took place in many areas - politics, theology, natural science, and metaphysics - and its scope is reflected in this collection of papers. The efforts of advocates of Cartesianism to produce a biography of Descartes, and the political difficulties they faced, are no less a part of the problems of Cartesianism than are the difficulties alleged against the Cartesian ontology of thought and extension in accounting for transubstatiation. Seventeenth- and eighteenth-century theories of the formation of the earth, for example, were historically part of the same set of problems as the difficulties in Bible criticism. These significant issues and many others are discussed in this volume. (shrink)

Philosophy and Christianity make truth claims about many of the same things. They both claim to provide answers to the deep questions of life. But how are they related to one another? Four Views on Christianity and Philosophy introduces readers to four predominant views on the relationship between philosophy and the Christian faith and their implications for life. Each author identifies the propositional relation between philosophy and Christianity along with a section devoted to the implications for living a life devoted (...) to the pursuit of wisdom. -/- The contributors and views include: -/- Graham Oppy—Conflict: Philosophy Trumps Christianity K. Scott Oliphint—Covenant: Christianity Trumps Philosophy Timothy McGrew—Convergence: Philosophy Confirms Christianity Paul Moser—Conformation: Philosophy Reconceived Under Christianity. (shrink)

Background: The Declaration of Helsinki, the World Medical Association’s statement of ethical guidelines regarding medical research, is published in the three official languages of the WMA: English, French and Spanish.Methods: A detailed comparison of the three official language versions was carried out to determine ways in which they differed and ways in which the wording of the three versions might illuminate the interpretation of the document.Results: There were many minor linguistic differences between the three versions. However, in paragraphs 1, 6, (...) 29, 30 and in the note of clarification to paragraph 29, there were differences that could be considered potentially significant in their ethical relevance.Interpretation: Given the global status of the Declaration of Helsinki and the fact that it is translated from its official versions into many other languages for application to the ethical conduct of research, the differences identified are of concern. It would be best if such differences could be eliminated but, at the very least, a commentary to explain any differences that are unavoidable on the basis of language or culture should accompany the Declaration of Helsinki. This evidence further strengthens the case for international surveillance of medical research ethics as has been proposed by the WMA. (shrink)

Although medical providers rely on similar tools to “treat” intersex and trans individuals, their enactment of medicalization practices varies. To deconstruct these complexities, we employ a comparative analysis of providers who specialize in intersex and trans medicine. While both sets of providers tend to hold essentialist ideologies about sex, gender, and sexuality, we argue they medicalize intersex and trans embodiments in different ways. Providers for intersex people are inclined to approach intersex as an emergency that necessitates medical attention, whereas providers (...) for trans people attempt to slow down their patients’ urgent requests for transitioning services. Building on conceptualizations of “giving gender,” we contend both sets of providers “give gender” by “giving sex.” In both cases too, providers shift their own responsibility for their medicalization practices onto others: parents in the case of intersex, or adult recipients of care in the case of trans. According to the accounts of most providers, successful medical interventions are achieved when a person adheres to heteronormative gender practices. (shrink)

The growing practice of returning individual results to research participants has revealed a variety of interpretations of the multiple and sometimes conflicting duties that researchers may owe to participants. One particularly difficult question is the nature and extent of a researcher’s duty to facilitate a participant’s follow-up clinical care by placing research results in the participant’s medical record. The question is especially difficult in the context of genomic research. Some recent genomic research studies — enrolling patients as participants — boldly (...) address the question with protocols dictating that researchers place research results directly into study participants’ existing medical records, without participant consent. Such privileging of researcher judgment over participant choice may be motivated by a desire to discharge a duty that researchers perceive themselves as owing to participants. However, the underlying ethical, professional, legal, and regulatory duties that would compel or justify this action have not been fully explored. (shrink)

Hookups are uncommitted sexual encounters that range from kissing to intercourse and occur between individuals in whom there is no current dating relationship and no expressed or acknowledged expectations of a relationship following the hookup. Research over the last decade has begun to focus on hooking up among adolescents and young adults with significant research demonstrating how alcohol is often involved in hooking up. Given alcohol’s involvement with hooking up behavior, the array of health consequences associated with this relationship, as (...) well as its increasing prevalence from adolescence to young adulthood, it is important to determine the predictors and consequences associated with alcohol-related hooking up. The current review extends prior reviews by adding more recent research, including both qualitative and experimental studies (i.e. expanding to review more diverse methods), research that focuses on the use of technology in alcohol-related hookups (i.e. emerging issues), further develops prevention and intervention potentials and directions, and also offers a broader discussion of hooking up outside of college student populations (i.e., expanding generalization). This article will review the operationalization and ambiguity of the phrase hooking up, the relationship between hooking up and alcohol use at both the global and event levels, predictors of alcohol-related hooking up, and both positive and negative consequences, including sexual victimization, associated with alcohol-related hookups. Throughout, commentary is provided on the methodological issues present in the field, as well as limitations of the existing research. Future directions for research that could significantly advance our understanding of hookups and alcohol use are provided. (shrink)

A growing body of literature critical of ethics review boards has drawn attention to the processes used to determine the ethical merit of research. Citing criticism on the bureaucratic nature of ethics review processes, this literature provides a useful provocation for (re)considering how the ethics review might be enacted. Much of this criticism focuses on how ethics review boards _deliberate,_ with particular attention given to the lack of transparency and opportunities for researcher recourse that characterise ethics review processes. Centered specifically (...) on the conduct of ethics review boards convened within university settings, this paper draws on these inherent criticisms to consider the ways that ethics review boards might enact more communicative and deliberative practices. Outlining a set of principles against which ethics review boards might establish strategies for engaging with researchers and research communities, this paper draws attention to how _Deliberative communication_, _Engagement with researchers_ and the _Distribution of responsibility_ for the ethics review might be enacted in the day-to-day practice of the university human ethics review board. This paper develops these themes via a conceptual lens derived from Habermas’ (The theory of communicative action. Volume 1: Reason and the rationalization of society, 1984 ) articulation of ‘communicative action’ and Fraser’s (Social Text, 25(26), 56–80, 1990 ) consideration of ‘strong publics’ to cast consideration of the role that human ethics review boards might play in supporting university research cultures. _Deliberative communication_, _Engagement with researchers_ and the _Distribution of responsibility_ provide useful conceptual prompts for considering how ethics review boards might undertake their work. (shrink)

One quality of remarriage comedies is that, for all their ingratiating manners, and for all the ways in which they are among the most beloved of Hollywood films, a moral cloud remains at the end of each of them. And that moral cloud has to do with what is best about them. What is best are the conversations that go on in them, where conversation means of course talk, but means also an entire life of intimate exchange between the principal (...) pair. We are bound to remember from these films, even years after viewing them, something of their sound: of conversation between Cary Grant and Irene Dunne in The Awful Truth, or between Grant and Rosalind Russell in His Girl Friday, or Grant and Katharine in Bringing up Baby, or those two together with James Stewart in The Philadelphia Story, or between Hepburn and Spencer Tracy in Adam’s Rib. We feel that these people know one another, and they know how to play together in a way to make one happy and hope for the best. But the moral cloud has to do with what that conversation is meant to do, and what I say about those films is that the conversation is in service of the woman’s sense of herself as in need of an education. Importantly for that reason, I call her a descendent of Nora in Henrik Ibsen’s A Doll’s House, who in one of the most celebrated moments in modern theater, ends a play by closing a door behind her. She leaves the dollhouse saying to her husband that she requires an education and that he is not the man who can provide it for her. The implication is that since he is not this man, he cannot be her husband. And implying the contrary as well: if he were, then he would be, and their relationship would accordingly—“miracle of miracles”—constitute a marriage. Stanley Cavell is the Walter M. Cabot Professor of Aesthetics and the General Theory of Value at Harvard University. His most recent works include In Quest of the Ordinary: Lines of Skepticism and Romanticism , This New Yet Unapproachable America , and Conditions Handsome and Unhandsome. (shrink)

States have implemented a variety of legal and policy approaches to address the overdose epidemic. Some approaches, like increasing access to naloxone and connecting overdose survivors with evidence-based treatment, have a strong public health foundation and a compelling evidence base. Others, like increasing reliance on punitive criminal justice approaches, have neither. This article examines law and policy changes that are likely to be effective in reducing overdose-related harm as well as those that are likely to increase it.